Aboriginal Staff Research Articles

How universities can support Aboriginal and Torres Strait Islander peoples to achieve self-determination and improved wellbeing.

The right to self-determination is enshrined in international law, affirming Aboriginal people have the right to make decisions about matters that affect their lives, including meeting their social, political, cultural and economic needs. This paper explores the role of universities in supporting Aboriginal self-determination, including an examination of the importance of the social and cultural determinants of wellbeing and the impacts of assimilation on Aboriginal people’s ability to live in accord with cultural traditions. Insights into how universities can create more culturally appropriate learning environments are also reviewed with a particular focus on the fundamental differences between Western and Aboriginal culture, pedagogy, epistemology, ontology, and axiology. The paper suggests that by undertaking a process of truth telling, universities will be able to create improved learning and research environments for Aboriginal students and staff that better support self-determination. By doing this, universities will leverage their unique position of influence to create improved wellbeing for Aboriginal people and the nation as a whole. This is an invited article based on a HERDSA keynote address, which was presented at the 2024 conference held in Adelaide, 8-11 July. Dr Callaghan was also invited to provide a video introduction to the article. The video link may be found on the ASRHE journal site next to the link to the PDF.

Patterns of health workforce turnover and retention in Aboriginal Community Controlled Health Services in remote communities of the Northern Territory and Western Australia, 2017–2019

BackgroundAboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs’ geographical and demographic characteristics.MethodsThe study used 2017–2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels.ResultsThere was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and ‘other health workers’ combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01).ConclusionsParticipating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs’ resources and may also support quality of service delivery due to improved cultural safety and continuity of care.

Aboriginal young people's experiences of type 2 diabetes diagnosis, management and support: A qualitative study in the Kimberley region of Western Australia.

In Australia, Aboriginal and Torres Strait Islander young people in remote settings are most-affected by young onset type 2 diabetes (T2D). It is necessary to understand young people's experiences, including factors impacting on self-management, to improve models of care. A phenomenological methodology underpinned this qualitative study in Western Australia's Kimberley region. Two Aboriginal Community Controlled Health Services supported recruitment of seven Aboriginal young people aged 12-24 with T2D, who participated in interviews. A carer and health professional of one young person in each site were also interviewed and relevant medical record data reviewed to assist with triangulation of data. De-identified transcripts were inductively coded and a coding structure developed with oversight by a Kimberley Aboriginal researcher. Young people reported varied experiences and emotions relating to a T2D diagnosis. Most recounted this was upsetting and some reported current negative impact on emotional wellbeing. Challenges with understanding and managing diabetes were highlighted, particularly regarding healthy eating, physical activity and medication. Family are a prominent source of self-management support, with the intergenerational impact of diabetes being evident for each participant. Positive relationships with health professionals, entailing continuity of care, were valued. There are significant emotional and medical challenges for young people with T2D and their families. Recommendations from this work will contribute to the development of local resources and initiatives to improve diabetes-related support. SO WHAT?: Alongside broader efforts to support good health at the societal level, enhanced health education and family-oriented support structures including Aboriginal clinical staff for young people with T2D are needed.

Aboriginal young people’s experiences of Cultural Safety in mental health services in two regions of New South Wales, Australia

This article assesses the Cultural Safety of mainstream mental health services in two regions of New South Wales, Australia, based on the experiences and perspectives of Aboriginal young people aged 16 – 25. Yarning semi-structured in-depth interviews were conducted with thirteen Aboriginal young people in two regions of New South Wales. Thematic analysis was undertaken by all research members to identify themes from the data and conceptual connections between them. Identified themes from individual analysis and coding were triangulated during several analysis meetings to finalize key themes and findings. Aboriginal young people identified that Aboriginal Community Controlled Health Services offered culturally safe Social and Emotional Wellbeing service supports, whereas mainstream mental health services did not. Aboriginal young people proposed that institutional reforms such as increasing engagement with cultural competency programs, employing more Aboriginal staff, and implementing culturally meaningful services, would increase Cultural Safety in mainstream mental health services. Cultural Safety within mainstream mental health services should be enhanced to ensure the subjective Social and Emotional Wellbeing support needs of Aboriginal young people are understood, addressed, and supported. Without Aboriginal young people having confidence that mainstream mental health services and systems are prioritising Cultural Safety when providing supports, mainstream mental health systems risk failing to reduce mental health and Social and Emotional Wellbeing disparities unjustly experienced by Aboriginal young people in New South Wales.

Health from the Grassroots, Listening to Mob

Abstract&#x0D; Background: There is opportunity for Universities to actively engage with Aboriginal communities to participate, conduct, and ideally lead, responsible research that attends to community priorities and issues. The Health from the Grassroots (Grassroots) project seeks to address an ongoing mismatch between university-defined priorities and community-defined priorities in rural [***]. Grassroots, led by Aboriginal staff of the [***], is a community engagement project aimed at engaging Aboriginal communities in conversations to inform research priorities. This paper describes the project vision, implementation, and lessons learned in the first years.&#x0D; &#x0D; Approach: The Grassroots project was a true representation of collaborative research led by and for Aboriginal people. We designed and conducted a local survey and yarning sessions with community members and used this information to design a “rich picture” to report findings and engage in further conversation with communities about evolving health and research priorities.&#x0D; We identified strengths and challenges faced by communities and health services in the region. The Aboriginal research team centred community in decision-making for project design and direction.&#x0D; Lessons Learned: Challenges encountered included limited resources and devoted time for the research team as this project occurred alongside staffs’ substantive positions. Community members were highly engaged in the consultation process and the rich picture continues to be used to further conversations about research action.&#x0D; Conclusions: Deep-rooted relationships and identities as members of the Community in which we live, and work enabled meaningful consultation to inform research action. Research priorities identified through the Grassroots project have been integrated into the ongoing work of the [***].

Development of an Aboriginal Resilience and Recovery Questionnaire – a collaboration between practitioners and help-seeking clients of a Victorian Aboriginal community controlled health service

BackgroundIndigenous experiences and perspectives of resilience, healing and recovery from trauma is gaining increasing attention, with a growing qualitative literature that spans multiple indigenous cultural groups. However, few quantitative measures are available. In this article, development of a preliminary version of the Aboriginal Resilience and Recovery Questionnaire is described.AimThe first aim of this study was to describe findings from two focus groups that provided theoretical knowledge and development of items for a draft version of an Aboriginal Resilience Recovery Questionnaire. The second aim of the study was to conduct a preliminary psychometric analysis of the properties of the measure.DesignMulti-method research design grounded in indigenous research methodologies.MeasuresAboriginal Resilience and Recovery Questionnaire, Australian Aboriginal Version of the Harvard Trauma Questionnaire Trauma symptom subscale, Growth and Empowerment Measure.Results(1) Two focus groups with six counselling staff from an Aboriginal health service were run that explored Victorian Aboriginal understandings of resilience, healing, and recovery from trauma. Sixty different protective factors viewed as potentially important to resilience, healing and recovery from trauma were identified by participants. (2) Following a review of the resilience literature, 75 items were reviewed and revised, with additional items developed by the focus group. (3) The final outcome was 60 items selected for a preliminary version of the Aboriginal Resilience Recovery Questionnaire, 50 of which made up 19 different subscales in addition to 10 single items. (4) Structured interviews were conducted with 81 help seeking Aboriginal clients recruited from the same health service. Preliminary psychometric assessment of the Aboriginal Resilience Recovery Questionnaire was undertaken using Principal Components Analysis. Two component subscales were extracted with adequate internal consistency and good convergent and discriminant validity. For both subscales there were moderate to strong positive associations with empowerment, and moderate to strong negative associations with trauma symptom severity.ConclusionThe preliminary results are promising for a strength-based resilience measure developed from the knowledge of Aboriginal practitioners and staff of a counselling service. Further research to address some psychometric limitations in the measure is required. A larger sample size will allow for a common factor analysis to be conducted. The Aboriginal Resilience Recovery Questionnaire has potential to assist Aboriginal Community Controlled Health Organisations and other organisations to evaluate whether services and programs can effectively support community members to strengthen individual, relational, community and cultural resilience resources.

Community-based Aboriginal staff taking the lead in family support: a case study of transforming practices prompted by the COVID-19 pandemic

ABSTRACT The Play to Connect programme is an ongoing action research project investigating implementation of a parenting programme for families and children living in disadvantaged remote Aboriginal communities in Australia’s Northern Territory. The aim of this research was to identify critical skills and supports needed for community staff to deliver family support services in their community. The presented collaborative research project was undertaken by two community-based Aboriginal implementation officers and two visiting practitioners between March 2020 and December 2021. At this time, social service delivery was impacted by COVID-19 lockdown restrictions when visiting staff were temporarily permitted to fly into remote communities. The visiting practitioners interviewed the local Aboriginal community staff after family visits to explore how to build their professional competencies and contribute to the nature of programme delivery. Thematic analysis of the interviews and debriefing notes emphasise three key factors crucial in building professional competencies: experiential and reflective learning; partnership and collaboration; and increased self-efficacy. The promising practices identified have potential for broader application across Aboriginal communities to enhance cross-cultural and multi-disciplinary teamwork for service delivery. These professional development processes can ensure more accessible programmes for Indigenous communities based on cultural relevance and the diverse needs of participating families.

An Australian National Survey of First Nations Careers in Health Services

A strong First Nations health workforce is necessary to meet community needs, health rights, and health equity. This paper reports the findings from a national survey of Australia’s First Nations people employed in health services to identify enablers and barriers to career development, including variations by geographic location and organisation type. A cross-sectional online survey was undertaken across professions, roles, and jurisdictions. The survey was developed collaboratively by Aboriginal and non-Aboriginal academics and Aboriginal leaders. To recruit participants, the survey was promoted by key professional organisations, First Nations peak bodies and affiliates, and national forums. In addition to descriptive statistics, logistic regression was used to identify predictors of satisfaction with career development and whether this varied by geographic location or organisation type. Of the 332 participants currently employed in health services, 50% worked in regional and remote areas and 15% in Aboriginal Community-Controlled Health Organisations (ACCHOs) with the remainder in government and private health services. All enablers identified were associated with satisfaction with career development and did not vary by location or organisation type. “Racism from colleagues” and “lack of cultural awareness,” “not feeling supported by their manager,” “not having role models or mentors,” and “inflexible human resource policies” predicted lower satisfaction with career development only for those employed in government/other services. First Nations people leading career development were strongly supported. The implications for all workplaces are that offering even a few career development opportunities, together with supporting leadership by Aboriginal and Torres Strait Islander staff, can make a major difference to satisfaction and retention. Concurrently, attention should be given to building managerial cultural capabilities and skills in supporting First Nations’ staff career development, building cultural safety, providing formal mentors and addressing discriminatory and inflexible human resources policies.

Better cardiac care – the patient experience – a qualitative study

BackgroundIn 2015, a Brisbane tertiary hospital’s cardiac unit implemented a new model of multidisciplinary care (Better Cardiac Care (BCC)) for Aboriginal and Torres Strait Islander patients. Since then, clinical indicators for Aboriginal and Torres Strait Islander cardiac patients have improved, but the recipients’ voices have not been heard. This research aimed to determine the acceptability and appropriateness, features of value, and opportunities for improvements in this model of care, from the perspective of patients and their family members.MethodsThis descriptive qualitative study employed a narrative methodology. BCC Health Workers contacted prospective participants; with consent, interested individuals were then contacted by the Aboriginal Research Officer (RO) who arranged yarning sessions and consent. Family members were also invited to share their stories of their loved ones’ hospitalisation. Two researchers conducted the interviews, using a yarning approach. Inductive narrative analysis, informed by Aboriginal and Torres Strait Islander ways of Being, Knowing, and Doing, focused on enabling participants’ stories to be heard and understood from their perspectives.ResultsRelationality was at the heart of the BCC model of care, particularly between patients and Aboriginal and Torres Strait Islander staff. The relationality included a responsibility for holistic care, extending beyond hospital discharge, although support and handover for family members required improvement. The Aboriginal and Torres Strait Islander staff understood the contextual and structural challenges faced by participants, including the disempowerment and racism experienced in healthcare. This understanding was shared with the BCC team who, in turn, protected, advocated for, and holistically supported participants through their cardiac health journeys.ConclusionsEmpowering (and employing) Aboriginal and Torres Strait Islander staff, and relating to patients as people, enabled BCC to meet Aboriginal and Torres Strait Islander patient’s needs and improve outcomes. The wider health system and health academia could benefit from exploring and valuing Aboriginal and Torres Strait Islander discourses of relationality.

The social and emotional wellbeing needs of Aboriginal staff in out of home care: Walking in two worlds

BackgroundThere is a disproportionate representation of Aboriginal children in the Australian Out of Home Care system. An important strategy to ensure Aboriginal children experience trauma informed care that is culturally situated is to have access to Aboriginal practitioners. The experiences of Aboriginal practitioners working in Aboriginal Out of Home Care have not been explored thoroughly. Participants and settingThis community led research was undertaken on Dharawal Country on the South Coast of the Illawarra region, Australia with an Out of Home Care program managed by an Aboriginal Community Controlled Organisation. The study included Aboriginal (n = 50) and non-Aboriginal (n = 3) participants connected through employment or community membership to the organisation. ObjectiveWe aimed to explore the wellbeing needs of Aboriginal practitioners working with Aboriginal children in Aboriginal Out of Home Care. MethodsThis co-designed qualitative research project used yarning sessions (individual and group), co-analysis with co-researchers, document analysis and reflexive writing. FindingsAboriginal practitioners are required to bring their cultural expertise to their work and with this, there is an expectation of cultural leadership and the fulfilling of cultural responsibilities. These elements bring with them emotional labour that must be acknowledged and accounted for in working in the Out of Home Care sector. ConclusionThe findings point to the importance of establishing an organisational social and emotional wellbeing framework in recognition of Aboriginal practitioner's specific needs, centring cultural participation as a key wellbeing and trauma informed strategy.

Delivery of tobacco control programs by Aboriginal Community Controlled Health Organisations in New South Wales, Australia: A cross-sectional survey.

To describe the characteristics of tobacco control programs (TCPs) delivered by Aboriginal Community Controlled Health Services (ACCHSs) in New South Wales (NSW), Australia. A key informant from each ACCHS in NSW completed a 30-item online survey. For each TCP, ACCHSs were asked to provide: the target population group, program aims and activities, funding source, and whether the program had been monitored or evaluated and reflected principles of community control and engagement. Twenty-five of 38 eligible ACCHSs completed the survey (66% response rate). Overall, 64% of services reported currently delivering at least one TCP, almost all of which aimed to promote quitting (95%). Programs involved brief intervention for tobacco cessation (71%), referral to quit services (67%), or use of printed resources (67%). Funding sources included Local Health Districts (52% of programs), the Commonwealth Government (48%) and NSW Ministry of Health (43%). Most programs were aimed at all Aboriginal people who smoke (76%); 19% targeted women or families during pregnancy/birth. Many TCPs used culturally tailored resources (86%) and employed Aboriginal staff (86%), and 48% had been evaluated. A third of participating ACCHS did not have a specific TCP to address smoking among Aboriginal people, and delivery of programs was characterised by an uncoordinated approach across the state. Aboriginal staff and culturally tailored messages were a focus of existing TCP programs. SO WHAT?: Findings highlight the need for more investment in TCPs for Aboriginal people to ensure all ACCHSs can deliver evidence-based programs.

Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations?

BackgroundThe COVID-19 pandemic increased the use of telehealth consultations by telephone and video around the world. While telehealth can improve access to primary health care, there are significant gaps in our understanding about how, when and to what extent telehealth should be used. This paper explores the perspectives of health care staff on the key elements relating to the effective use of telehealth for patients living in remote Australia.MethodsBetween February 2020 and October 2021, interviews and discussion groups were conducted with 248 clinic staff from 20 different remote communities across northern Australia. Interview coding followed an inductive approach. Thematic analysis was used to group codes into common themes.ResultsReduced need to travel for telehealth consultations was perceived to benefit both health providers and patients. Telehealth functioned best when there was a pre-established relationship between the patient and the health care provider and with patients who had good knowledge of their personal health, spoke English and had access to and familiarity with digital technology. On the other hand, telehealth was thought to be resource intensive, increasing remote clinic staff workload as most patients needed clinic staff to facilitate the telehealth session and complete background administrative work to support the consultation and an interpreter for translation services. Clinic staff universally emphasised that telehealth is a useful supplementary tool, and not a stand-alone service model replacing face-to-face interactions.ConclusionTelehealth has the potential to improve access to healthcare in remote areas if complemented with adequate face-to-face services. Careful workforce planning is required while introducing telehealth into clinics that already face high staff shortages. Digital infrastructure with reliable internet connections with sufficient speed and latency need to be available at affordable prices in remote communities to make full use of telehealth consultations. Training and employment of local Aboriginal staff as digital navigators could ensure a culturally safe clinical environment for telehealth consultations and promote the effective use of telehealth services among community members.

Don't Follow the Smoke-Listening to the Tobacco Experiences and Attitudes of Urban Aboriginal Adolescents in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

Preventing smoking among young Aboriginal people is important for reducing health inequities. Multiple factors were associated with adolescent smoking in the SEARCH baseline survey (2009-12) and discussed in a follow-up qualitative study that aimed to inform prevention programs. Twelve yarning circles were facilitated by Aboriginal research staff at two NSW sites in 2019 with 32 existing SEARCH participants aged 12-28 (17 female, 15 male). Open discussion around tobacco was followed by a card sorting activity, prioritising risk and protective factors and program ideas. The age of initiation varied by generation. Older participants had established smoking in their early adolescence, whereas the current younger teens had little exposure. Some smoking commenced around high school (from Year 7), and social smoking increased at age 18. Mental and physical health, smoke-free spaces and strong connections to family, community and culture promoted non-smoking. The key themes were (1) drawing strength from culture and community; (2) how the smoking environment shapes attitudes and intentions; (3) non-smoking as a sign of good physical, social and emotional wellbeing; and (4) the importance of individual empowerment and engagement for being smoke-free. Programs promoting good mental health and strengthening cultural and community connections were identified as a priority for prevention.

‘It’s Us, Or Maybe No One’: Yarning With Aboriginal Social and Emotional Wellbeing Workers From the Kimberley Region of Western Australia

Objective Social and Emotional Wellbeing (SEWB) describes the holistic model of health and wellbeing advocated for by Aboriginal and Torres Strait Islander peoples. This research explored the experiences of Aboriginal peoples employed in SEWB service delivery to identify enablers, challenges, and requirements of growing a sustainable, and empowered SEWB workforce. Methods We used a yarning methodology with seven Aboriginal SEWB workers located at Aboriginal Community Controlled Health Organisations across the Kimberley region of Western Australia. Results Three key SEWB service delivery themes were identified: 1) Role of cultural identity; 2) Barriers and enablers of SEWB service provision; 3) Building the future of the SEWB workforce. Lessons Learned SEWB services, as delivered by Aboriginal peoples within Aboriginal Community Controlled Health Organisations, have great potential to comprehensively meet the health and wellbeing needs of Aboriginal peoples and communities. To optimally undertake their role, Aboriginal SEWB staff need to: have a clear understanding of their role; good relationships within their workplace; relevant sector knowledge; a strong sense of cultural safety within the workplace; and access to meaningful professional development. Understanding the barriers and enablers experienced by SEWB staff provides a platform to meaningfully develop the future Aboriginal SEWB workforce, and delivery of SEWB services.

Towards best practice during COVID-19: A responsive and relational program with remote schools to enhance the wellbeing of Aboriginal and Torres Strait Islander students.

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020-2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally.

Educator perspectives on implementing the Optometry Aboriginal and Torres Strait Islander health curriculum framework

ABSTRACT Clinical relevance Aboriginal and Torres Strait Islander Peoples have the right to the highest attainable standard of health and access to health services without discrimination. To uphold these rights, it is important that optometry students are educated in Aboriginal and Torres Strait Islander health and culturally safe practice. Background An Aboriginal and Torres Strait Islander health curriculum framework is now mandatory for optometry programs to implement. This study explores the experiences of those involved in implementing this framework and, from their perspectives, what is and is not working. Methods Heads and educators involved in Aboriginal and Torres Strait Islander health curriculum at Australian optometry programs participated in a mixed-methods study. Information about pedagogy and contextual issues impacting curriculum implementation was collected through surveys and interviews. The design and analysis were underpinned by constructivist grounded theory. Results Most programs had at least partially implemented components of the curriculum framework. While partnerships were considered essential to success, this remains a work in progress. Authentic learning through clinical placement was considered a priority. Assessment was described as complex and not yet adequately addressed. Only 37% of educators felt fully prepared to teach and 6% to assess this curriculum. More workload allocation, funding and recruitment of Aboriginal and Torres Strait Islander staff and students through institutional commitment and leadership were perceived requirements. Conclusion Further developing sustainable partnerships where there is reciprocity between optometry programs and Aboriginal and Torres Strait Islander educators and communities is critical to effectively implementing Aboriginal and Torres Strait Islander health curriculum. While clinical placement was considered an important learning experience, the type of experience and whether or not all students should attend require further consideration. Additionally, educators need support for professional development and sharing resources in this emerging field. This will contribute to improving culturally safe practice in optometry.

Counter stories: The voices of Indigenous peoples undertaking educative roles in flexi schools

This paper reports on findings from the first author’s doctoral research examining the experiences of Aboriginal and Torres Strait Islander staff in Australian flexi schools. ‘Collaborative yarning methodology’ story boarding was used to hear (and theme) the collective experiences of Indigenous teaching and non-teaching staff in these alternative school settings where both they and Indigenous students make up larger numbers of staff than mainstream schools. Informed by Indigenist and critical race theory, 19 Indigenous staff members contributed to knowledge around three themes: Us Mob; Race and racism, and School Practice which incorporated discussions both of curriculum and of issues related to funding. Many Indigenous staff were working in flexi schools through choice and a sense of commitment to working with Indigenous youth. However other issues, such as experiences of racism, were still present despite the ‘social justice’ nature of flexi schools.

Healing journeys: experiences of young Aboriginal people in an urban Australian therapeutic community drug and alcohol program.

Disproportionately high numbers of Aboriginal young people access residential alcohol and other drug programs in Australia. While demand is high, these programs often have low numbers of Aboriginal staff. Residential programs, however, generally offer supports that reflect features of Aboriginal health care - holistic, group-based, connected to local communities, and addressing determinants of health. The qualitative research outlined in this paper was a collaboration between a mainstream residential therapeutic community program and two Aboriginal community-controlled organisations, and Aboriginal young people and researchers, with Aboriginal research leadership. It used an Aboriginal healing framework to understand the experiences of 12 young Aboriginal people in the program, triangulated with 19 key informant interviews. This provided an opportunity to understand how Indigenous knowledge about healing related to mainstream programs and the experiences of Aboriginal young people. This moves beyond individualist and deficit-focused conceptions of youth alcohol and drug use and centres Aboriginal cultures as healing. Findings point to the need for critically self-reflective mainstream organisations, a larger Aboriginal workforce with leadership roles, partnerships with Aboriginal Elders and organisations, and an investment in Aboriginal community-controlled alcohol and other drug services.

"No One Manages It; We Just Sign Them Up and Do It": A Whole System Analysis of Access to Healthcare in One Remote Australian Community.

Objective: To assess the accessibility, availability and utilisation of a comprehensive range of community-based healthcare services for Aboriginal people and describe contributing factors to providing effective healthcare services from the provider perspective. Setting: A remote community in New South Wales, Australia. Participants: Aboriginal and non-Aboriginal health and education professionals performing various roles in healthcare provision in the community. Design: Case study. Methodology: The study was co-designed with the community. A mixed-methods methodology was utilised. Data were gathered through structured interviews. Descriptive statistics were used to analyse the availability of 40 health services in the community, whilst quotations from the qualitative research were used to provide context for the quantitative findings. Results: Service availability was mapped for 40 primary, specialised, and allied health services. Three key themes emerged from the analysis: (1) there are instances of both underservicing and overservicing which give insight into systemic barriers to interagency cooperation; (2) nurses, community health workers, Aboriginal health workers, teachers, and administration staff have an invaluable role in healthcare and improving patient access to health services and could be better supported through further funding and opportunities for specialised training; and (3) visiting and telehealth services are critical components of the system that must be linked to existing community-led primary care services. Conclusion: The study identified factors influencing service availability, accessibility and interagency cooperation in remote healthcare services and systems that can be used to guide future service and system planning and resourcing.

BOURDIEU MIGHT UNDERSTAND: INDIGENOUS HABITUS CLIVÉ IN THE AUSTRALIAN ACADEMY

ABSTRACT Bourdieu’s concept of habitus clivé illuminates Indigenous Australians’ experiences in tertiary environments for both Aboriginal students and Aboriginal staff. Habitus formed through family, schooling and social class is also shaped by urban, regional or rural upbringing, creating a durable sense of self. Aboriginal people in Australia live in all of these places, often in marginalised circumstances. Bourdieu’s more specific concept of habitus clivé, or divided self, is less well known than habitus, but offers value in giving expression to Indigenous people’s experiences within a dominant White society. The complexity of participation and educational change is explored here through the experiences of three authors’ intersecting positionalities within the Australian academy. Developing more nuanced scholarly language reduces the imposition of perspectives that see Indigenous people as objects within western frameworks. Scholarly understanding and respect for Australia’s first peoples’ concepts and cultural practices would engage more appropriately and fairly with Aboriginal knowledge and society. Habitus clivé chronicles one version of habitus that can be changed or be reconfirmed but not easily or by fiat. Understanding the concept can be learned, however. Educational opportunity, glorified in today’s higher education, means little for Aboriginal people without long-term strategies addressing existentially and culturally split habitus.