Indigenous Children In Australia Research Articles

Embedding speech pathology in an Aboriginal community-controlled playgroup: Perceptions from the community

Colonisation in Australia has had long-term, pervasive, detrimental impacts on Indigenous Australians. When measured by national benchmarks, Indigenous children in Australia are currently at increased risk of developmental difficulties in comparison to their non-Indigenous peers. Community-led initiatives, such as playgroups, can provide safe and developmentally stimulating environments for Indigenous infants and young children, and deliver lasting benefits. These contexts also provide opportunities for collaborative approaches to develop children’s early communication skills. A participatory action research approach was applied to explore parent/carer perspectives about incorporating speech pathology into an existing community-led Aboriginal playgroup in an urban context. The speech pathology service took the form of information sharing sessions between the speech pathologist and the playgroup members. Collaborative planning and implementation of the project was followed by discussion among the participants and co-researchers about the cultural safety and helpfulness of the speech pathology service. The complexity of incorporating services delivered by non-Indigenous people in an Aboriginal community-controlled playgroup was acknowledged. The information sharing sessions were regarded as helpful and acceptable by the community. However, in the planning and implementation of the service, cultural and community needs must be considered as a precedent and priority to ensure a culturally safe and strong environment.

Trajectories of otitis media and association with health determinants among Indigenous children in Australia: the Longitudinal Study of Indigenous Children

ObjectivesIndigenous children in Australia experience high burden of persistent otitis media (OM) from very early age. The aim was to identify distinct trajectories of OM in children up to age 10–12 years and examine the association with socio-economic determinants. Study designA multistage clustered national panel survey. MethodsThe study analysed the birth cohort of the Longitudinal Study of Indigenous Children from 2008 to 2018, comprising 11 study waves. Group-based trajectory modelling was used to identify different trajectories of OM outcome. Multinomial logistic regression was applied to examine the relationship between trajectories and individual, household and community-level socio-economic determinants. ResultsThis analysis included 894 children with at least three responses on OM over the 11 waves, and the baseline mean age was 15.8 months. Three different trajectories of OM were identified: non-severe OM prone, early/persistent severe OM and late-onset severe OM. Overall, 11.4% of the children had early/persistent severe OM from birth to 7.5 to nine years, while late-onset severe OM consisted of 9.8% of the children who had first OM from age 3.5 to five years. Children in communities with middle and the highest socio-economic outcomes have lower relative risk of early/persistent severe OM (adjusted relative risk ratio = 0.39, 95% confidence interval = 0.22–0.70 and adjusted relative risk ratio = 0.22, 95% confidence interval = 0.09–0.52, respectively) compared to children in communities with lowest socio-economic outcomes. ConclusionEfforts to close the gap in the quality of life of Indigenous children must prioritise strategies that prevent severe ear disease (runny ears and perforation), including improved healthcare access, reduced household crowding, and better education, and more employment opportunities.

72 Prevalence of Neurodevelopmental Disorder among Indigenous Children: A Systematic Review

Abstract Background Neurodevelopment involves sensory-motor, cognitive, and social-emotional domains, which can be influenced by biological and psychosocial factors. Poor neurodevelopment can result in missing developmental milestones and neurodevelopmental disorders (NDs) that translate into negative consequences for long-term health and well-being. Indigenous children in countries with similar colonial histories face a disproportionate burden of infant mortality, chronic diseases, injuries, and disability compared to non-Indigenous children. However, there is no consensus on the prevalence of NDs among Indigenous children around the world. Objectives This systematic review (PROSPERO 2021 CRD42021238669) synthesized current evidence on the prevalence of NDs among Indigenous children in Australia, Canada, New Zealand, and the USA. Design/Methods Comprehensive searches of five databases from 2005 to Feb 15, 2021 were conducted to identify cohort and cross-sectional studies that assessed the objective. Two independent reviewers conducted study selection, data extraction/analysis, and risk of bias assessment. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and ecological studies (adapted), and the Quality Assessment Tool for Prevalence Studies by Hoy et al. for cross-sectional studies. Prevalence odds ratios (pOR) with 95% confidence intervals (CI) were calculated in random-effects meta-analyses for each ND outcome if there were two or more studies of the same study design. Results Of the 864 studies identified, 25 studies met the inclusion criteria. Twelve studies were conducted in Australia, one in Canada, four in New Zealand, and eight in the USA. Four studies evaluated attention-deficit/hyperactivity disorder (ADHD) prevalence, 13 for autism spectrum disorder (ASD), 10 for intellectual disability (ID), and five for motor disorders (MD). Most cohort studies (10/17) had high risk of bias. All cross-sectional studies (n=8) had low risk of bias. The prevalence of ADHD, ASD, ID, and MD for Indigenous children ranged from 2.7-3.9%, 0.07-3.0%, 1.1-3.9%, and 0.18-0.47%, respectively. Prevalence in non-Indigenous children ranged from 1.6-5.6%, 0.31-3.3%, 0.87-2.3%, and 0.22-0.37%. In cross-sectional studies, Indigenous children had decreased odds of ASD (three studies; pOR=0.80; 95% CI: 0.71-0.89) compared to non-Indigenous children. In cohort studies, higher odds of MD (two studies; pOR=1.57; 95%CI: 1.35-1.84) and lower odds of ASD (four studies; pOR=0.46; 95% CI: 0.28-0.76) were found in Indigenous children compared to non-Indigenous children. Conclusion Prevalence rates are greater in Indigenous children for MD and lower for ASD compared to their non-Indigenous counterparts. Differences in NDs prevalence between Indigenous and non-Indigenous children may be due to differences in access to health care services/assessment.

Cutaneous infection and atopic dermatitis: the importance of early intervention in Indigenous children in Australia

Cutaneous infection and atopic dermatitis: the importance of early intervention in Indigenous children in Australia

Does artificial intelligence have a role in telehealth screening of ear disease in Indigenous children in Australia?

Does artificial intelligence have a role in telehealth screening of ear disease in Indigenous children in Australia?

\u201cWhat are we doing to our babies\u2019 teeth?\u201d Barriers to establishing oral health practices for Indigenous children in South Australia

BackgroundDuring the 1970s, optimal oral health was experienced more frequently amongst Indigenous children in Australia than their non-Indigenous counterparts. As a result of public health interventions targeting oral disease, oral health has improved for most children; however, Indigenous children today experience oral disease at alarmingly high rates. A history of colonisation, assimilation, racism and cultural annihilation has had profound impacts on oral health for Indigenous peoples; compounded by environmental dispossession and a shift from traditional diets to one of processed and nutrient-poor foods, often high in sugar.MethodsThis project aimed to identify factors related to the increased occurrence of caries in Indigenous children. Using purposive sampling from the larger project, this paper thematically analyses 327 motivational interviews to explore current barriers impeding parental efforts to establish oral health and nutrition practices for Indigenous children. Representation of socioeconomic positions of families were compared across themes, as based on maternal age, employment, residency and number of children in care.ResultsFindings resulted in a conceptual model of barriers that exist across knowledge, social, structural and parental factors. Major thematic results include: social consumption of processed foods, busy households, misleading nutrition marketing, sugar cravings and lack of oral health and nutrition knowledge.ConclusionA discussion of the findings results in the following recommendations increased oral health promotion efforts in non-metropolitan areas; utilisation of community experiences in creating strategies that encourage oral health and nutrition knowledge; and the extension of oral health initiatives and future research to include all family members.Trial registration Australian New Zealand Clinical Trial Registry ACTRN12611000111976; registered 01/02/2011.

Other People’s Children

Integrating personal stories of maternal connection and separation with a detailed analysis of the 2018 crisis of migrant family separation in the United States, this autoethnographic essay examines the continuum between parental responsibility and collective engagement for the greater good. A comparison is made between the current crisis of family separation and the case of the Stolen Generations of Indigenous children in Australia, particularly the tendency toward collective forgetting. The essay calls for the protective and compassionate impulses felt in the midst of this crisis to be translated into democratic participation and empowered voices raised in resistance.

Correction: Cost-effectiveness analysis of a mobile ear screening and surveillance service versus an outreach screening, surveillance and surgical service for indigenous children in Australia.

[This corrects the article DOI: 10.1371/journal.pone.0138369.].

Academic self-concepts of Aboriginal and/or Torres Strait Islander children from the Longitudinal Study of Indigenous Children

Abstract Self-concept is recognised as useful in facilitating understanding of the development of resilience, academic achievement and social and emotional maturity in children. This framework is valuable for studying minorities such as Indigenous children, for who a positive self-concept is a means of bolstering resilience and mitigating the inherited structural disadvantages of colonisation. This paper aims to understand the academic self-concept of Indigenous children in Australia through analysis of univariate, bivariate and multivariate data of Indigenous children aged 9.5–11 years from the Longitudinal Study of Indigenous Children Wave's 7 K Cohort. Results show overall positive levels of Indigenous children's self-perception at school. Further, factors such as level of relative isolation, teacher perception, peer relationships, feedback from mother and contact with community leaders and Elders is positively associated with Indigenous children's schooling mathematic and reading self-concepts. Ensuring that Indigenous students are supported by community, peers and parents, immersed in their culture and are recognised and supported by their teachers can alleviate the undesirable effects that structural inequalities may have on their academic self-concept.

“You Betray Your Country”: Remembering and Forgetting the Stolen Generations in the Metropolitan Press

ABSTRACTIn 1997, the Human Rights and Equal Opportunity Commission released Bringing Them Home, documenting historical practices of forced Indigenous child removal in devastating detail. The report was released into a fractious political environment in which historicised understandings of race were being heatedly debated. Responses to the report played out through the media as conservatives sought to reassert a traditional narrative of Australian history. The Howard Coalition government steadfastly refused to implement most recommendations of the report, including a formal national apology. The government’s stance, and its capacity to dominate the news cycle, almost immediately shifted public focus from the contents of the report to its reception. This reframing meant that, when a formal national apology was finally offered by the incoming Rudd Labor government in 2008, it offered closure not to 220 years of racial violence as was claimed, but to a 20-year acrimonious debate dominated by white elites. This process demonstrates the ways that, against the starkest evidence, institutional power can be leveraged to facilitate widespread forgetting of historical violence inflicted upon Indigenous peoples. Indigenous children in Australia continue to be removed from their families at heavily disproportionate rates.

Follow-up of Intervention to Prevent Dental Caries Among Indigenous Children in Australia

For an intervention delivered in early childhood to have meaningful translational effect, long-term follow-up is necessary, especially among underserved indigenous children among whom preventable dental disease is common. To test the long-term effectiveness of an early-childhood dental intervention through a follow-up at age 5 years among Aboriginal children in Australia. This secondary analysis of a randomized clinical trial followed up on participants of the Baby Teeth Talk Study, a 2-group parallel, outcome assessor-blinded, randomized clinical trial conducted among Aboriginal children in South Australia, Australia. Participants included 448 mother or caregiver-child dyads who were enrolled in the Baby Teeth Talk trial between February 2010 and May 2011 and were randomized in the present trial to the immediate intervention group or the delayed intervention group. Intention-to-treat principles were used for all data analyses to estimate the effect of the intervention on dental caries experience. Data analysis was performed from April 10 to May 27, 2019. The intervention comprised 4 services to participants: (1) dental care to mothers during pregnancy, (2) application of fluoride varnish to children's teeth, (3) anticipatory guidance in the form of oral health educational packages, and (4) motivational interviewing for pregnant mothers and children at ages 6, 12, and 18 months in the immediate intervention group and at ages 24, 30, and 36 months in the delayed intervention group. The primary outcome was the mean number, in the primary dentition, of decayed, missing, or filled teeth (dmft) at age 5 years. Individual components of the dmft index were examined, as was the prevalence of dmft greater than 0. Of the 449 Aboriginal mothers and children recruited, 223 (49.7%) were randomized to the immediate intervention group and 225 (50.1%) to the delayed intervention group. The mean dmft at age 5 years was 2.10 (95% CI, 2.04 to 2.16) for children in the immediate intervention group and 2.91 (95% CI, 2.83 to 3.00) for children in the delayed intervention group (adjusted mean difference, -1.02; 95% CI, -1.81 to -0.22). When considering children in nonmetropolitan locations, the differences were stark; the mean dmft was 2.46 (95% CI, 2.38-2.54) for children in the immediate intervention group and 3.65 (95% CI, 3.53 to 3.78) for children in the delayed intervention group, with an adjusted mean difference of -1.52 (95% CI, -2.61 to -0.43). Most of this difference was accounted for by missing teeth, with the mean number of missing teeth of children in the immediate intervention group living in nonmetropolitan locations being 0.29 (95% CI, 0.27 to 0.31) compared with 1.02 (95% CI, 0.96 to 1.07) for their counterparts in the delayed intervention group. A 3-fold difference was observed in the percentage of missing teeth greater than 0 between children in the immediate intervention group and those in the delayed intervention group (10.8 [95% CI, 10.2 to 11.4] vs 31.0 [95% CI, 30.1 to 31.8]). This trial found that a multifaceted initiative to reduce early-childhood caries continued to be efficacious in participating indigenous children aged 5 years, especially those residing in nonmetropolitan locations and with teeth missing because of dental disease. anzctr.org.au Identifier: ACTRN12611000111976.

Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children.

Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities. This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia. Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification. Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = -1.27, 95% CI = -9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = -0.03, 95% CI = -0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score. Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children. The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.

Closing the health gap for Indigenous children in Australia

Alex Brown is an Australian Aboriginal medical doctor and researcher, and is the Director of the Wardliparingga Aboriginal Research Unit at the South Australian Health and Medical Research Institute (Adelaide, SA). From his years of working on Aboriginal health, he has witnessed firsthand the impact the poorer health of the country's Aboriginal and Torres Strait Islander people, compared with the non-Indigenous population, is having on communities.

Risk factors and mitigation of influenza among Indigenous children in Australia, Canada, United States, and New Zealand: a scoping review.

This review considers prominent risk factors and mitigation strategies of influenza among Indigenous children. Seven electronic databases were searched from the period of 2004-2017 to locate articles discussing influenza among Indigenous children in the developed circumpolar nations of Australia, Canada, United States, and New Zealand. Articles selected for inclusion discussed influenza among Indigenous children as either individuals or as a part of a community. Ancestry searches of articles meeting the review criteria were also undertaken to discern seminal research in this topic area. From the 39 primary research studies included, marked risk factors and mitigation strategies of influenza among Indigenous children were identified using inductive analysis. Notable risk factors included age under 2 years, cigarette smoke exposure, presence of a chronic illness, and crowded living conditions. Successful mitigation of influenza for Indigenous children included strategies to improve vaccine coverage, provision of health education, and policy change. In the past, the impact of influenza upon Indigenous communities has been devastating for both children and their families. By utilizing existing public health infrastructure and collaborating with culturally unique Indigenous groups, preventive action for Indigenous children at significant risk of contracting influenza can be realized.

Salivary characteristics and dental caries experience in remote Indigenous children in Australia: a cross-sectional study

BackgroundWhile associations between salivary characteristics and dental caries have been well studied, we are not aware of this being assessed in a remote Indigenous child population, where lifestyles may be different from urban children. Our aim was to assess associations between caries experience and putative biomarkers in saliva, accounting for oral hygiene and dietary habits.MethodsChildren attending schools in an Indigenous community in remote north Queensland, Australia were invited to an oral examination by qualified and calibrated examiners. Salivary flow rate, pH, buffering capacity and loads of mutans streptococci (MS), lactobacilli (LB) and yeasts were determined. Also, data on tooth brushing frequency and soft drinks consumption were obtained via a questionnaire. Caries experience was recorded by the International Caries Detection and Assessment System (ICDAS-II), and quantified as decayed, missing and filled surfaces. Relationships between the salivary variables and the cumulative caries experience (dmfs+DMFS) in the deciduous and permanent dentitions were examined by multivariate analyses to control the effect of confounders.ResultsThe mean cumulative decayed (DS + ds), missing (MS + ms) and filled (FS + fs) surfaces were 3.64 (SD: 4.97), 1.08 (4.38) and 0.79 (1.84) respectively. Higher salivary MS and LB counts, low tooth brushing frequency and daily soft drink consumption were significantly related to greater caries experience. Caries experience was about twice in those with ≥10^5 CFU/ml saliva counts of MS (mean = 6.33, SD: 8.40 vs 3.11, 5.77) and LB (7.03, 7.49 vs 4.41, 8.00). In the fully-adjusted multivariate model, caries experience in those with higher counts of MS and LB were 51 and 52% more than those with lower counts.ConclusionsAs with studies in other populations, childhood salivary counts of MS and LB were significantly associated with greater caries experience in this remote Indigenous community. To address the serious burden of oral disease, we are researching ways to promote a healthy oral environment by encouraging good dietary habits, and emphasising the importance of daily tooth brushing with a fluoridated toothpaste. Our ongoing longitudinal studies will indicate the success of measures employed to reduce the counts of bacteria closely associated with cariogenesis and their impact on caries increment.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527; date of registration: 3rd July 2015.

Childcare Use and Its Role in Indigenous Child Development: Evidence from the Longitudinal Study of Indigenous Children in Australia

We investigate patterns of childcare use and its influence on the cognitive development of Indigenous children. The influence of childcare on Indigenous children's cognitive outcomes is less well understood than for non‐Indigenous children due to a lack of appropriate data. We focus on a cohort of Indigenous children in Australia who have been followed from infancy and for whom rich information on childcare use and cognitive outcomes is observed. Compared to Indigenous children who never participated in childcare, Indigenous children who participated in childcare performed better on several early cognitive outcomes. Using regression and propensity score matching, we show that this difference is driven by selection into childcare, with children from more advantaged families being more likely to attend formal childcare. However, matching analysis results suggest that relatively disadvantaged children might benefit more from attending childcare, as indicated by the positive estimated effects found for those who never attended childcare.

Systematic literature review to identify methods for treating and preventing bacterial skin infections in Indigenous children

Bacterial skin infections in Indigenous children in Australia frequently lead them to access primary health care. This systematic review aims to identify and analyse available studies describing the treatment and prevention of bacterial skin infections in Indigenous children. Electronic databases including Scopus, MEDLINE, CINAHL, ProQuest, Informit and Google Scholar were searched. Studies in English published between August 1994 and September 2016, with the subject of bacterial skin infections involving Indigenous children and conducted in Australia, New Zealand, the USA or Canada were selected. Initially 1474 articles were identified. After the application of inclusion and exclusion criteria, 10 articles remained. Strategies for the treatment and prevention of bacterial skin infections included the management of active infections and lesions, improving environmental and personal hygiene, the installation of swimming pools and screening and treatment. There is a need for more, rigorous, large-scale studies to develop evidence for appropriate, culturally acceptable methods to prevent and manage bacterial skin infections in Indigenous children in Australia. The problem is complex with multiple determinants. Until underlying socioeconomic conditions are addressed skin infections will continue to be a burden to communities.

The impact of racial discrimination on the health of Australian Indigenous children aged 5\u201310\xa0years: analysis of national longitudinal data

BackgroundA growing body of literature highlights that racial discrimination has negative impacts on child health, although most studies have been limited to an examination of direct forms of racism using cross-sectional data. We aim to provide further insights on the impact of early exposure to racism on child health using longitudinal data among Indigenous children in Australia and multiple indicators of racial discrimination.MethodsWe used data on 1239 Indigenous children aged 5–10 years from Waves 1–6 (2008–2013) of Footprints in Time, a longitudinal study of Indigenous children across Australia. We examined associations between three dimensions of carer-reported racial discrimination (measuring the direct experiences of children and vicarious exposure by their primary carer and family) and a range of physical and mental health outcomes. Analysis was conducted using multivariate logistic regression within a multilevel framework.ResultsTwo-fifths (40%) of primary carers, 45% of families and 14% of Indigenous children aged 5–10 years were reported to have experienced racial discrimination at some point in time, with 28–40% of these experiencing it persistently (reported at multiple time points). Primary carer and child experiences of racial discrimination were each associated with poor child mental health status (high risk of clinically significant emotional or behavioural difficulties), sleep difficulties, obesity and asthma, but not with child general health or injury. Children exposed to persistent vicarious racial discrimination were more likely to have sleep difficulties and asthma in multivariate models than those with a time-limited exposure.ConclusionsThe findings indicate that direct and persistent vicarious racial discrimination are detrimental to the physical and mental health of Indigenous children in Australia, and suggest that prolonged and more frequent exposure to racial discrimination that starts in the early lifecourse can impact on multiple domains of health in later life. Tackling and reducing racism should be an integral part of policy and intervention aimed at improving the health of Australian Indigenous children and thereby reducing health disparities between Indigenous and non-Indigenous children.

The burden of invasive infections in critically ill Indigenous children in Australia.

To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia. Retrospective multi-centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data. All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 - 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset. Population-based ICU mortality and admission rates. Invasive infections accounted for 23.0% of non-elective ICU admissions of Indigenous children (726 of 3150), resulting in an admission rate of 47.6 per 100 000 children per year. Staphylococcus aureus was the leading pathogen identified in children with sepsis/septic shock (incidence, 4.42 per 100 000 Indigenous children per year; 0.57 per 100 000 non-Indigenous children per year; incidence rate ratio 7.7; 95% CI, 5.8-10.1; P <0.001). While crude and risk-adjusted ICU mortality related to invasive infections was not significantly different for Indigenous and non-Indigenous children (odds ratio, 0.75; 95% CI, 0.53-1.07; P = 0.12), the estimated population-based age-standardised mortality rate for invasive infections was significantly higher for Indigenous children (2.67 per 100 000 per year v 1.04 per 100 000 per year; crude incidence rate ratio, 2.65; 95% CI, 1.88-3.64; P <0.001). The ICU admission rate for severe infections was several times higher for Indigenous than for non-Indigenous children, particularly for S. aureus infections. While ICU case fatality rates were similar, the population-based mortality was more than twice as high for Indigenous children. Our study highlights an important area of inequality in health care for Indigenous children in a high income country that needs urgent attention.

Alcohol management plans in Indigenous communities in Queensland (Australia) may have unintended implications for the care of children.

BackgroundIndigenous children in Australia are more likely than non-Indigenous children to be in contact with the child safety system. A large number of Queensland’s Indigenous population live in remote and isolated communities in north Queensland where the state government's Alcohol Management Plans (AMPs) are in effect. In these communities it is an offence to have in one’s possession more than the regulated amount and type of alcohol. A breach of these restrictions can result in convictions under the Liquor Act 1992.FindingsDuring an evaluation of AMPs, influential stakeholders and key service providers voiced their belief that a conviction for a breach of the AMP would impact a person’s eligibility to hold a Positive Notice Blue Card (PNBC). On its own, however, a breach of the Liquor Act 1992 will not impact a person’s eligibility for a PNBC. A PNBC is required for any person volunteering or working with children. Without a PNBC, a person is ineligible to work in child-related employment, volunteer at child-related activities or provide out-of-home care for children.ConclusionThis misconception needs to be addressed in these already-disadvantaged communities to ensure that Indigenous community members have every opportunity to hold a PNBC. Focused strategies with evaluation and research are needed in this important policy area.