Browsing by Subject "Aboriginal and Torres Strait Islander Health"

One month before the June 2007 Federal Government Emergency Intervention in the Northern Territory some 55 West Australian Aboriginal child protection workers attended a 3-day summit in Fremantle. Their purpose as front-line practitioners from across the State was to identify how more nurturing and healing communities could be developed and supported in a climate of despair. This paper reports on how the summit was designed and on some of the ideas and concerns that emerged within this dialogical space of cooperative inquiry. The project was a partnership between Aboriginal and non-Aboriginal representatives of university, government, and community-service bodies. Aboriginal practitioners identified the complexity of what was happening in their experience and where changes were needed. Integral to this participation and coproduction of knowledge by Aboriginal child protection workers was the provision of a safe space for the articulation of reflected experience. Implications for policy, practice, and curriculum of both process and outcome dimensions to considering Aboriginal views on this contentious issue are discussed.

Indigenous Australian people in the remote West Kimberley region of Western Australia experience extreme disadvantage as a legacy from 128 years of European colonial rule. I bring to this study a unique insider perspective as a Yimardoowarra marnin, an Indigenous woman from the Mardoowarra, Fitzroy River, researching local people and communities. This research has been a deep personal and shared journey with the Nyikina people, as we made meaning of both the construction of disadvantage and strategies to reduce the impact of disadvantage in the West Kimberley. Utilization of a cultural action research framework, with mixed methods of data collection, opened up an understanding of Indigenous disadvantage and strategies to overcome it in one particular context. Narratives of the Elders and other Nyikina people, plus multiple information sources, identified that the processes of systemic racism, established during the early colonial period, have evolved to maintain an endemic state of structural violence. This process has been responsible for the overwhelming disadvantage experienced by Indigenous people in the West Kimberley.

Suicide is an enormous problem in the Kimberley, a region in northern-Western Australia. An 18-year-old Indigenous male is seven-times more likely to die by suicide, compared to his non-Indigenous peers. 'Alive and Kicking Goals!' (AKG) was a pilot program that took an innovative approach to suicide prevention peer education. Players from the Broome Saints Football Club formed a youth sub-committee. Guided by a Project Mentor (PM), these young men undertook training in suicide prevention in order to become Peer Educators (PEs) for the Kimberley region. AKG created a safe space for healing which allowed these young men to come to terms with the 'cycle of grief' experienced in the region. AKG also tackled suicide stigma as the PEs, who were well-respected sportsmen, demonstrated that seeking help does not display weakness. At the conclusion of the pilot, 16 young men became PEs. They learned practical skills in suicide awareness and prevention which they can teach within and across the different communities within the Kimberley region. Preliminary results from this pilot have informed ways in which AKG can be developed for the future. Further research can indicate to long-term positive impacts.

Background: The health and well-being of Indigenous people is a significant global problem, and Aboriginal Australians suffer from a considerably higher burden of disease and lower life expectancy than the non-Indigenous population. Intellectual disability (ID) can further compromise health, but there is little information that documents the prevalence of ID among indigenous populations. This study provides information on ID among the Aboriginal population of Western Australia. Methods: The Disability Services Commission (DSC) of Western Australia has maintained a statewide database of people with ID since 1953. Data on people of Aboriginal descent were extracted from the DSC database and linked to two other state-based databases, the Hospital Morbidity Data System and the Deaths Registry, with additional linkage to the National Death Index. The linked data were used to assess the prevalence, survival patterns and causes of death in Aboriginal people with ID. Results: Although comprising 3.5% of the population, Aboriginal Australians represented 7.4% of all people registered for ID services. The level of ID was assessed as borderline or mild in 40.7% of cases, moderate in 19.9%, severe or profound in 12.1%, but had not been specified in 27.2% cases. Median survival was 55.1 years for men and 64.0 years for women, with a mean age at death (n = 102) of 19.6 years. The leading causes of death were respiratory diseases, diseases of the circulatory system, and accidents. Conclusions: The study presents unique population summary data for ID in the Aboriginal community of Western Australia. To provide appropriate prevention and intervention strategies, there is an urgent need for more detailed information on the prevalence and patterns of ID.

Objectives: To develop culturally appropriate and effective strategies to reduce the risk from pandemic influenza (H1N109) in rural and remote Australian Aboriginal and Torres Strait Islander communities. Methods: Participatory Action Research (PAR) approach that enabled communities and researchers to work together to develop understanding and take action to reduce risk. Results: The H1N109 pandemic raised deep concerns and serious issues in all of the Aboriginal and Torres Strait Islander communities involved in this project. The participants expressed distrust and scepticism in relation to current Australian health policies on containment and told the researchers that specific plans for Aboriginal and Torres Strait Islander peoples were needed. Respondents indicated that policies and plans had been developed without respectful engagement with communities. The strong and recurring themes that emerged from the PAR cycles were: the importance of family; ways of life and realities of living in response to influenza; and key messages to government and health services to focus on communication, understanding and respect. Conclusion: The essential work of reducing risk of pandemic influenza with Aboriginal and Torres Strait Islander communities is not straightforward, but this project has highlighted a number of useful pathways to continue to journey along with communities. A number of strategies to reduce the spread of pandemic influenza in Aboriginal and Torres Strait Islander communities were identified. These strategies would make a good starting point for conversations with communities and health services. In Aboriginal and Torres Strait Islander communities the environment, community structures and traditions vary. Respectful engagement with communities is needed to develop effective policy.

Background: Improving timely immunisation is key to closing the inequitable gap in immunisation rates between Aboriginal children and non-Indigenous children. Aboriginal Immunisation Officers were employed in Hunter New England Local Health District (HNELHD), New South Wales (NSW), Australia, to telephone the families of all Aboriginal infants prior to the due date for their first scheduled vaccination. Methods: Aboriginal Immunisation Officers contacted the families of Aboriginal children born in the Hunter New England Local Health District (HNELHD) by telephone before their due immunisation date (pre-call) to provide the rationale for timely immunisation, and to facilitate contact with culturally safe local immunisation services if this was required. The impact of this strategy on immunisation coverage rates is reviewed. Results: For the period March 2010 to September 2014 there was a significant increase in immunisation coverage rate for Aboriginal children at 12 months of age in HNELHD (p < 0.0001). The coverage in the rest of NSW Aboriginal children also increased but not significantly (p = 0.218). Over the full study period there was a significant decrease in the immunisation coverage gap between Aboriginal children and non-Indigenous children in HNELHD (p < 0.0001) and the rest of NSW (p = 0.004). The immunisation coverage gap between Aboriginal and non-Indigenous infants decreased at a significantly faster rate in HNELHD than the rest of NSW (p = 0.0001). By the end of the study period in 2014, immunisation coverage in HNELHD Aboriginal infants had surpassed that of non-Indigenous infants by 0.8%. Conclusions: The employment of Aboriginal immunisation officers may be associated with closing of the gap between Aboriginal and non-Indigenous infants' immunisation coverage in HNELHD and NSW. The pre-call telephone strategy provided accelerated benefit in closing this gap in HNELHD.

A crucial objective of the Australian Government’s Closing the Gap program is to improve Aboriginal health, and to achieve morbidity and mortality rates similar to those for non-Indigenous Australians. Reducing public health risks due to drinking water of unknown quality will help to close the gap. Factors such as hardness, taste, colour and odour of water may influence perceptions of risk and quality. Increased contact and familiarity with a hazard is associated with individuals becoming desensitised and habituated to its presence, so that their risk judgements may reflect their behavioural experiences. Consumption of water of unknown quality, such as rainwater, instead of treated town water in Australian Aboriginal communities may be a community norm, a part of a community’s culture or a result of lack of trust in government water suppliers. Partnerships between service providers and communities can ensure that the service is responsive to community needs, is conducted in a culturally appropriate manner and is beneficial to the community. Governance of drinking water in Aboriginal communities cannot be comprehensive without active engagement of the communities involved, and greater understanding of cultural issues, perceptions and behaviours towards drinking water quality. This Perspective article reviews the literature to shed light on the need to consider New South Wales (NSW) Aboriginal perceptions about drinking water and its acceptability. We urge more dialogue and research, and a policy focus that includes partnerships with discrete NSW Aboriginal communities to develop a deeper understanding of perceptions of drinking water and encourage consumption of safe water.

This chapter explores what it means to work collaboratively in Aboriginal and Torres Strait Islander social work, and to situate collaboration as key to the development and articulation of social work practice with Aboriginal and Torres Strait Islander people. The aim is to develop the capacity for workers in social work and the human services from different cultural backgrounds and service contexts to establish purposeful and respectful working relationships with each other and with Aboriginal and Torres Strait Islander people, leaders and Elders, communities and services in order to achieve common goals. One of the assumptions underpinning this chapter is that the values, skills, knowledge and protocols that inform collaborative work, relationship building and the development of partnerships are all essential for culturally respectful and effective social work. Fundamentally, this means acknowledging the colonial practices that have shaped and continue to influence the Australian social work profession. The second assumption is that non-Indigenous social workers do have an important role to play in Aboriginal and Torres Strait Islander social work, but in order to do this effectively there is a need to work in partnership with Aboriginal and Torres Strait Islander people. Having the capacity to work together reflects the social justice and human rights foundations of our profession. The power of collaboration can lead to significant change and capacity building for all workers, communities and services. These skills and values are transferable to all practice contexts and groups.

A recent rural community gathering, designed to bring together rural Indigenous and non-Indigenous community members and leaders, was held and provided an important forum for Aboriginal people to share perspectives about Australia's aspirations to 'Close the Gap' between Indigenous and non-Indigenous people. The aim of this report is to disseminate the sentiment that percolated in the presentations and discussion arising from the gathering. This report demonstrates how rural Close the Gap champions can influence the uptake of healthy choices in their communities, at the front line of change.

Introduction: Rural and remote communities of Australia, particularly those including Aboriginal people, experience greater morbidity and mortality across a range of health outcomes compared to urban communities. Previous national data have demonstrated that rural and remote communities experience a disproportionate burden of communicable diseases compared to their urban counterparts. This systematic review was undertaken to describe the types of research that have explored the epidemiology of communicable diseases in rural and remote communities in Australia, with particular reference to the social determinants of health. Methods: We conducted a keyword search of several databases (EMBASE, MEDLINE/PubMed, RURAL, Aboriginal and Torres Strait Islander Health Database, Web of Science Core Collection, and Google and Google Scholar websites) for peer-reviewed and grey literature that described or analysed the epidemiology of communicable diseases in rural and/or remote communities of Australia from 2004 to 2013. Exclusion criteria were applied to keep the review focused on rural and/or remote communities and the population-level epidemiological analysis of communicable diseases. Results: From 2287 retrieved articles, a total of 50 remained after applying exclusion criteria. The majority of included articles were descriptive studies (41/50). Seven of the total 50 articles contained analytical studies; one systematic literature review and one experimental study were also identified. Due to the diversity of approaches in measuring disease burden, we performed a narrative synthesis of the articles according to the review objectives. Most of the articles investigated the disease burden in remote (n=37/50) and Aboriginal communities only (n=21/50). The studies highlighted a high prevalence or incidence of skin, eye and respiratory infections for remote Aboriginal communities, particularly children over the past decade. There was emerging evidence to suggest that housing and social conditions play an important role in determining the risk of skin, ear, respiratory and gastrointestinal infections in children. Other health service and sociocultural factors were also discussed by authors as influencing the epidemiology of communicable diseases in rural and remote communities. Conclusions: This systematic review identified several communicable diseases that continue to cause considerable morbidity in remote Aboriginal communities, including skin, eye and respiratory infections, particularly for children. Overall there is a substantial amount of descriptive epidemiology published, but few analytical or experimental studies. Despite a lack of empirical investigation into the social determinants of the burden of communicable disease, there is emerging evidence that has demonstrated a significant association between housing conditions and skin, ear, respiratory and gastrointestinal infections in children. There is also growing recognition of other social and environmental factors that can influence the burden of diseases in rural and remote communities. Further investment into higher quality community-based research that addresses the social determinants of communicable diseases in remote communities is warranted. The lack of research investigating zoonoses and tropical diseases was noted.

Cultural beliefs and values implicitly and explicitly shape every aspect of the way we parent our children and how we communicate about parenting. To support parents appropriately in this new and challenging role, child health services for parents in Australia need to do more than acknowledge a diverse range of cultural practices. While many health professionals believe they act in culturally sensitive ways, we need to closely examine this belief, question the cultural assumptions implicit in the information we give, and assess the extent to which our interactions are culturally appropriate. In this paper, we present a critical review of the literature on health care provision for migrant women and families. We then suggest a need to re-examine the values, beliefs and attitudes within cultural frameworks that inform how child health professionals communicate. Specifically, communication between child health professionals and migrant parents requires further analysis. We suggest that professionals need to reflect on the cultural self rather than solely on the culture of others.

The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. 'Methods': Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. 'Results': Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. 'Conclusions': The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.

Torres Strait Islanders living in the Torres Strait region have the highest prevalence of Type 2 diabetes in Australia; more than three times the rate of other Australians. Abdominal obesity and insulin resistance are the main causes for these high rates of the disorder. Further, Aboriginal and Torres Strait Islanders diagnosed with diabetes have poorer glycaemic control and much lower rates of insulin use than non-Indigenous Australians diagnosed with Type 2 diabetes alongside extremely high rates of renal failure and other comorbidities. Interventions have been instigated in order to overcome these issues. Previously a simple recall system managed by local health workers achieved significant improvements in diabetes care, reduced diabetes-related hospitalisations by 40% and led to the implementation of a chronic disease register and recall system throughout the Torres Strait region. Nurses, Indigenous health workers and other health professionals play important roles in ensuring these intervention continue.

The issues facing families today are complex and multifaceted. Issues such as poverty, child maltreatment, substance use, and the stability of families all have an impact on the development of children (Lietz, Andereck, & Knopf, 2010). The issues for Australian Aboriginal families are compounded by the struggle to overcome the negative effects of the country's colonial past (Kulhánková, 2011), the traumas associated with the 'Stolen Generation' (Saggers, Walter, & Gray, 2011), and the fact that even this generation of Indigenous children is haunted by the legacy of the history of forceful removal of children from the homes of Indigenous families (Ewen & McCoy, 2011). However, little has actually been documented about Aboriginal childrearing practices, confirmed by health, government and non government representatives at the Aboriginal and Torres Strait Islander children and young people's health and wellbeing conference held at Lennons in Brisbane, Qld on 26th to 27th May 2010, which makes it harder for non-Indigenous Australians to understand Aboriginal approaches to childrearing. There have been a few research studies (Von Sturmer, 1980, Hamilton, 1981 and Kearins, 1984) that have described Aboriginal childrearing practices; in addition to this are the contemporary works of professionals such as Aboriginal Professor Helen Milroy (UWA) in Aboriginal Child and Adolescent Health, Prof. Robyn Penman, who conducted the Longitudinal Study of Indigenous Children, along with various other Aboriginal community organisations that provide Aboriginal family services. These studies provide seminal sources to inform the development of Aboriginal family service delivery. However there appears to have been a period of disengagement in the process of bringing together Aboriginal community knowledge and research based knowledge to inform family support policy development and services by governments that are acceptable and accessible to Aboriginal families.

This paper begins with a brief review of international research, which demonstrates the link between education and health, followed by an account of the quantitative, qualitative and theoretical studies carried out by the CRCATH. We acknowledge at the outset that the interpretation of empirical data on education–health links is highly contested. Sometimes, as we show, the data itself is ambiguous, or incomplete, especially the Australian data. But it is more difficult to arrive at a shared theoretical understanding of the two major variables: health and education. This is not as straightforward as simply examining their empirical 'markers' - such as child survival rates, years of schooling and literacy levels. Why? Because both health and education are cultural 'artefacts' or 'constructs', which mean different things to different people at different times. The confusion is magnified by the assumption of both health and education professionals that the paradigms of their own field transfer in a straightforward way to the other. The confusion becomes almost overwhelming when a cross-cultural dimension is added, because both Indigenous and non-Indigenous peoples have such diverse experiences of education from which to draw an understanding of it. The second part of this paper is a preliminary report into the progress we have made trying to achieve greater clarity about the meanings of the education–health link, and what action should flow from this in the specific context of Indigenous peoples' health. Our methodology was to undertake a series of semi-structured dialogues between two academically trained researchers - one an educationalist, the other a health professional - and a small number of Indigenous health leaders, including our co-author and project leader. These dialogues helped us to clarify meaning, and also addressed a key finding of the social determinants literature, namely that power and control are at the heart of health inequalities. The third part of the paper draws together these first two elements - the review of the research literature and the dialogue with the health leaders - to build some illustrative models of the way in which education can be better understood as both a determining factor in the reproduction of health inequalities, and as an active intervention into overcoming them. In the final section, we suggest some future directions for research and program development.

In Australia, colorectal cancer is the most commonly occurring internal cancer affecting both men and women, and the second most common cause of cancer-related death. Flexible sigmoidoscopy has not been commonly used as a screening tool in Australia due primarily to lack of resources. Until now, people at average risk of developing bowel cancer frequently undergo colonoscopy after referral to a specialist. To fill an identified need, a nurse practitioner-led colorectal screening service providing fecal occult blood testing and flexible sigmoidoscopy, health education and promotion, patient counseling, information and a referral point for general practitioners, and a referral service for above average-risk patients was established in a South Australian metropolitan teaching hospital. Establishment of this clinic required advanced and extended theoretical and clinical preparation for the nurse practitioner, as well as development of interdisciplinary relationships, referral processes, clinical infrastructure, and a marketing strategy. An audit of the first 100 flexible sigmoidoscopy patients revealed service and procedural outcomes that compared favorably with other colorectal screening services as well as a high level of patient satisfaction.

In this study, relevant in vitro biological activities were evaluated in extracts of Australian medicinal plants used in indigenous traditional medicine for the treatment of wounds, sores and other dermatological conditions. A survey of Australian medical ethnobotanical literature was conducted in order to identify suitable species and plant parts for inclusion in the study and to collect data for systematic and quantitative analyses of Australian indigenous medicinal plant use. Thirty-seven aqueous extracts were obtained following traditional methods of preparation from various parts of 23 plant species representing 15 families. Sequential solvent extracts (hexane-dichloromethane-methanol) were also prepared using material from 5 species of 'Eremophila' to enable comparison of bioactivity with corresponding traditional aqueous preparations. Extracts were screened using in vitro assays for anti-microbial activities, anti-oxidant capacity via DMPD decolourisation and Oxygen Radical Absorbance Capacity (ORAC) assays, P388D1 murine lymphoblast cytotoxicity, and inhibition of prostaglandin E2 from calcium ionophore-stimulated murine fibroblasts. Total phenolic content of the aqueous preparations was also estimated using a Folin-Ciocalteu type assay.

"Bioprospecting has gained much recent popular attention, particularly spurred by the apocryphal image of adventurous ethnobotanists penetrating at considerable peril the darkest recesses of the jungle at the behest of rich pharmaceutical firms". (Cox, 2008, p. 270) As Cox (2008) describes above, the discipline of bioprospecting often evokes images of brilliant but erratic ethnopharmacologists, as portrayed, for example, by Harrison Ford (Indiana Jones) and Sean Connery (Medicine Man); battling through thick jungles or mountainous terrain in search of an infallible panacea, used for millennia by indigenous people. However, by contrast with the Amazonian rainforest or the Himalayas, the Australian landmass is predominantly arid with deserts and temperate grasslands predominating. Such arid flat landscapes are where most of the recorded ethnopharmacologically significant Australian plants are found. Selective pressures in this geographically isolated arid land have nonetheless produced a higher proportion of total endemic flora, by comparison with the tropical or wet temperate islands of Oceania or indeed the rest of the world. Evolutionary biologists suggest that during prehistoric cycles of aridity, Australia's rich assortment of high secondary metabolite yielding flora emerged. This flora includes commercially important essential oil yielding species, such as 'Eucalyptus', 'Melaleuca' and 'Leptospermum' spp. Specific evolutionary advantages conferred on plants by characteristic secondary metabolites remain contentious. However, their contribution to the 'materia medica' of prehistoric Aboriginal people is beyond doubt.

Background: Continuous Quality Improvement is a process for raising the quality of primary health care (PHC) across Indigenous PHC services. In addition to clinical auditing using plan, do, study, and act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous PHC services in northern Australia to understand the systems used to support quality care. Methods: High-improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the Audit and Best Practice in Chronic Disease National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Precollected SAT data (from annual team SAT meetings) are presented longitudinally using radar plots for quantitative scores for each component, and content analysis is used to describe strengths and weaknesses of performance in each systems' component. Results: High-improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports, and engagement with other organizations and community, while the weaknesses included lack of service infrastructure, recruitment, retention, and support for staff and additional costs.

The grief following a suicide death has long been considered different to other forms of bereavement. One key feature of this difference is stigma which, in many societies and cultures, can leave the suicide bereaved isolated and disconnected from their community. Previous research examining the experiences of the suicide bereaved report feelings of being silenced-left both without a voice to articulate grief and without an audience to hear their stories. Facebook has occupied a somewhat dichotomous role within suicide research. Initially such social media was viewed with uncertainty, particularly as it remains difficult to ensure the safety of vulnerable people who disclose suicidal feelings in such open fora. This may be exacerbated by the fact that a person's number of Facebook 'friends' may advertise popularity but may not be indicative of their true connectedness to individuals or a community. However, the positive role Facebook can play in giving the suicide bereaved a voice in their grief-allowing them to tell their story-has been little examined. In remote communities, where access to traditional modes of help seeking can be limited by distance and lack of services, Facebook can be used positively to not only remain connected to others but also access information on services which can provide professional counselling and support. A case study in a remote Australian Aboriginal community demonstrates the ways in which Facebook has provided an accessible and valuable tool for an individual recently bereaved by suicide. By analysing the trajectory of the language used over time, and the way the story of grief was told, it can be seen that the use of Facebook facilitated healing and (re)connection to the community. This discourse opens up new ideas to the ways in which Facebook and other social media may be employed to better assist those experiencing grief, identify vulnerabilities and ensure greater connection to services at appropriate times for those who require them.

The social disadvantage of the Australian Aboriginal population, evidenced in measures of health, education, employment, and income, is the target of a current national policy of Close the Gap. Policy makers attuned to addressing the needs of the Aboriginal population writ large can be blind to a complex communal patterning of vulnerability within this larger category. This report details recent research into addressing the mistreatment of older Aboriginal people in Western Australia. Interviews with 37 (29 Aboriginal) front line practitioners with older Aboriginal people established that issues surrounding the mistreatment of older Aboriginal people are dissimilar to the pattern prevailing in the total Australian population. It is suggested that surviving as an 'us' against 'them' in a lived experience of discrimination and oppression has left some older Aboriginal people with an excess of bonding capital within their family and community and a deficit of bridging capital to wider forms of social support. This report details how Aboriginal practitioners and others focused on the importance of working with the intangibles of community at the local level to address the issue.

This paper describes the collaboration between an Aboriginal community and Western Australia's (WA) Department for Child Protection (DCP) in designing and operating a residential child care facility in a predominantly Aboriginal community. Research literature has established that the effective operation of child protection systems in remote Aboriginal communities requires practitioners and policy-makers to have awareness of local and extra-local cultural, historical and contemporary social factors in nurturing children. This ethnographic case study describes how a newspaper campaign heightened public and professional awareness of child abuse in the town of Halls Creek, in WA's Kimberley region. With its largely Aboriginal population, Halls Creek lacked the infrastructure to accommodate an inflow of regional people. Homelessness, neglect and poverty were widespread. Within a broader government and local response, DCP joined with community leaders to plan out of home care for children. Detailed are the importance and complexities of negotiating between universal standardised models of care and local input. Strategies for building positive relationships with children's family while strengthening both parenting capacity and community acceptance, and use of the facility are identified. Key to success was the development of a collaborative 'third-space' for threading together local and professional child protection knowledge.

Aboriginal suicidal behaviours in remote Australia present as very different phenomena to suicidal behaviours in mainstream Australian society. Multiple suicide threats and behaviours often appear to express ways of executing violence or retaliation, rather than the immediate wish to die. This may be a response to the lack of choices in the face of an historical context of intergenerational trauma, grief and loss. Aboriginal youth are grasping the possibility of death, and the threat of dying, as a violent means to gain control over their lives. This enactment of agency can give instant 'power' to those violent and vulnerable enough to use it. Using examples of such a suicidal crisis common within these communities, this paper argues that those who work within Australian Aboriginal communities need to better understand the continuing impacts of colonialism and inter-generational trauma and 'decolonisation'. Further, the approach taken in providing services to communities may need to be adapted from the more orthodox approach of linear referral pathways. Understanding the importance of cultural context and place allows for a more dynamic and beneficial therapeutic relationship to be formed. It may also help to more effectively facilitate support for healthcare workers.

The origins of this paper lie in our experiences of having heard too many stories with the same outcome or ending in the field of inquiry and practice described as "Aboriginal Mental Health." This paper was written in an attempt to make sense of these experiences. It does so by focussing on another type of outcome or story ending in mental health care/research contexts more widely known as [Recovery]. Not to be confused with the term recovery as it is used in addiction studies, the concept of [Recovery] currently underpinning mental health care policies and reform is at once a philosophy, a practice orientation, and a guiding value and principle. This paper emerged from a range of discussions about [Recovery] as a practice orientation and a particular type of story-ending told by those who receive and provide Aboriginal mental health care in North Queensland. Poetic inquiry was used as a way to respond to the questions that arose from these discussions. In the research projects and discussions that foreground and underpin this paper, the use of poetic reasoning and writing, evolved from using poetry as a reflective tool, to a being used as a method of data collection, data construction, analysis and interpretation (even though none of these words appropriately inscribe these aspects of research within Arts informed research practices). It is also posited as an aesthetic and ethical way of (re)presenting the results of inquiring. This paper (re)presents and unpacks a particular generated poem to demonstrate the approach (as it is and was) used. As an arts-informed approach to social inquiry and to writing, the purpose of this text is to open or introduce an awkward pause in an ongoing dialogue or conversation about Aboriginal people in mental health care and to amplify the Aboriginal voices informing the development of this text.

The provision of a well trained and culturally safe health workforce is critical to the alleviation of health inequities for Australian Indigenous peoples. Educating and graduating significant numbers of Indigenous registered nurses is one way the 'Close the Gap' initiative succeeds. Indigenous nurses bring a set of unique skills, knowledge and understanding to health service delivery. Their contribution has the potential to enhance future outcomes for Indigenous people by improving access to health services, ensure services are culturally appropriate and respectful, and assist non-Indigenous nurses to deliver culturally appropriate care. This paper discusses the background to the current numbers of Indigenous undergraduate nursing students enrolled in and completing tertiary nursing courses, with a focus on Queensland nursing programs. A range of identified barriers impede Indigenous nursing students' successful completion of their studies. We propose recommendations for education, research and employment to help overcome these problems, and ensure greater Indigenous participation in the nursing workforce.

Indigenous nurses have the potential to improve access to health services for Indigenous people by ensuring that services are culturally safe and respectful of Indigenous peoples' needs. Therefore, developing a well-educated Indigenous nursing workforce is one way to improve the poor health outcomes of Indigenous Australians. A mixed methods study was undertaken to determine the current rates of enrollment, progression and completion of Indigenous nursing students in Australia and to explore student and staff perceptions of barriers to completion and strategies for success. The results indicate that the national average completion rates are 36.3% for Indigenous nursing students and 64.6% for non-Indigenous nursing students - an average difference of 28.3%. Indigenous nursing students and academics identified barriers to completion, which were similar to those identified in previous research. Success strategies, however, revealed the importance of individual student characteristics; academics' knowledge, awareness, and understanding; relationships, connections, and partnerships; institutional structures, systems, and processes; and, family and community knowledge, awareness, and understanding. This paper offers an overview of the integration and interpretation process that makes up the final phase of a mixed methods study.

The aim of this work was to determine the feasibility of improving Aboriginal and Torres Strait Islander status recording for notifiable diseases using all Invasive Pneumococcal Disease (IPD) notifications in a regional area of New South Wales, Australia. In Australia people with IPD are nearly always admitted to hospital and their Aboriginal and Torres Strait Islander status is recorded. Aboriginal and Torres Strait Islander status was determined for IPD notifications by referring to the routine hospital admission data in a regional area of New South Wales, Australia. There were 234 notifications in the regional area of Hunter New England during the period 2007-2009. Initially, 168 (72%) notifications had Aboriginal and Torres Strait Islander status recorded. After referring to the routine hospital admission data, the recorded status increased to 232 (99%). Updating the surveillance data required less than five minutes per notification. Referring to routine hospital admission data proved a useful and time-efficient surveillance strategy to increase the proportion of notifications with Aboriginal and Torres Strait Islander status. These data can then be used to better understand the current epidemiology of IPD. Aboriginal and Torres Strait Islander children aged 0-4 years have a two- to threefold higher rate of invasive pneumococcal disease than non-Aboriginal children, thus high levels of timely pneumococcal immunization coverage remain important for young Aboriginal and Torres Strait Islander children.

In an era of metrification and managerialism there is widespread acceptance that a lack of Aboriginal wellbeing reflects a culture of welfare dependency. But Indigenous wellbeing is more complex than simple equations suggesting "getting off welfare" will achieve betterment. There is no one-size-fits-all solution to issues of Indigenous disadvantage. Social work literature establishes that moral, social, and political aspects of working the social are in tension with technical and rational aspects. This paper draws on Charles Wright Mills's concept of the "sociological imagination" to render an historical, social-structural, and biographical account of addressing wellbeing within West Australian Kimberley Aboriginal communities since the 1970s. Highlighting the actualities of community as shaped by time, place, and interaction, an argument is made for developing a social work imagination that researches "what is happening here" through ethnographic approaches that consider the intersectioning of history, biographies, and social systems. Without such local knowledge and engagement, effective social policy cannot be enacted from the centre.

Introduction: This article outlines the meaningful participation of eight Aboriginal and Torres Strait Islander community members employed as community researchers investigating the impact of pandemic influenza in rural and remote Indigenous communities in Australia. Aboriginal and Torres Strait Islander participation is now a requirement of health research involving Aboriginal and Torres Strait Islander communities. There is a growing literature on the different approaches to such involvement. Fundamental to this literature is an acknowledgement that Indigenous communities are no longer prepared to be research objects for external, mostly non-Indigenous researchers, and demand a role in decisions about what is researched and how it will be researched. In this paper, we describe the protracted process for site identification and recruitment and training of community researchers. We focus on the backgrounds of the Indigenous researchers and their motivations for involvement, and the strengths and challenges posed by Indigenous people researching in their own communities. Throughout the paper our concern is to document how genuine participation and the building of research capacity can occur. Discussion: A key feature of the research was the employment, training and strengthening the capacity of local Aboriginal and Torres Strait Islander community members in the role of community researchers. A series of training workshops were conducted in northern Australia and focussed on qualitative research methods, including data collection, data analysis and writing. The Indigenous researchers collected the community-based data, and worked in partnership with experienced academic researchers in the analysis and compilation of community reports. Parts of those community reports, as well as additional information supplied by the community researchers, forms the basis of this article. As the demand increases for involvement of Indigenous community members as researchers, focus needs to be paid to what constitutes meaningful participation. If active participation in all aspects of the research process is intended, this necessitates close attention to the knowledge and skills required for this to occur at every stage. Building research capacity means not simply equipping local people to undertake research on a particular project, but to have the knowledge and skills to undertake research in other areas. Conclusions: There are considerable benefits for Indigenous people researching in their own communities. Most important for the community researchers on this project was the sense that they were doing important health work, not just conducting research. Given the persistent gaps between Indigenous and non-Indigenous health, this is perhaps one of the most important contributions of this type of research. Whilst research outcomes are undoubtedly important, in many cases the process used is of greater importance.

Background: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. Method: Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: 'suicide', 'gatekeeper', 'training', 'suicide prevention training', 'suicide intervention training' and 'Indigenous'. Other internationally relevant descriptors for the keyword "Indigenous" (e.g. "Maori", "First Nations", "Native American", "Inuit", "Metis" and "Aboriginal") were also used. Results: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. Conclusion: Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

The focus of this paper is adult literacy, and the impact this has on Aboriginal and Torres Strait Islander individual and community health. It directs attention to those Aboriginal and Torres Strait Islander young people and adults who have not benefited from the formal school education system, and who, as a consequence, have very low levels of basic English language literacy. Analysing data from a range of sources, I suggest that these people comprise as much as 35% of the Aboriginal and Torres Strait Islander adult population nationally, and a much bigger proportion in some communities and regions. Moreover, they are key to improving overall health outcomes in the population as a whole, because they are among the people most at risk. Drawing on research in countries of the global South over recent decades, the paper then suggests that one of the most effective ways to improve health outcomes and foster health development is through a popular mass adult literacy campaign. Popular education is not formal education, of the kind provided by schools, TAFEs and universities. It is "non-formal" education, provided on a mass scale, to people in marginalised and disadvantaged communities, as part of wider social and political movements for equality. The paper concludes that this is the most appropriate form of education to deal with the massive social and economic inequality at the heart of the social determinants of Indigenous health.

Monty Hale (1934-2013) has left a rich history of his life in relation to the Nyulipartu people, the 1946 Pilbara strikes, Don 'Mirta' McLeod, the first independent Aboriginal school in Australia and much more. Winner of the 2012 Western Australian Premier's History Book Award, the book is an enduring Nyangumarta narrative of a time of huge adaptation for Hale and his language group. It is a collaborative production incorporating an English translation by Hale's daughter Barbara Hale and linguist Mark Clendon, with overall editing provided by historian Anne Scrimgeour. The book, more autoethnography than individualistic autobiography, captures both linguistic and historical perspective on the dynamics of social and cultural change occurring across the Pilbara landscape during one lifetime.

Australia has a higher proportion of endemic aromatic species than any other continent. Many novel medicinal plants have therefore been used by the Aboriginal people, particularly including species that produce high yields of volatile compounds. Volatiles are often related to the therapeutic effects, either directly or by complementing fixed medicinal compounds and therefore acting as associated congeners guiding harvest selection. Our research has provided support for this notion, particularly with members of the genus 'Eremophila (Scrophulariaceae)'. In this regard, medicinal usage modalities often involved ritualistic smoking ceremonies (smudging), heating bundles of leaves to produce intact volatiles, such as 'Eremophila bignoniiflora', or alternatively, topical treatments using lipophilic volatile and fixed components extracted into animal fats. Additionally, species outside of Eremophila, such as Pittosporum spp. '(Pittosporaceae), Callitris' spp. '(Cypressaceae)' or 'Geijera' spp. '(Rutaceae)', were also used in a similar manner and are further explored herein. Until now, comprehensive investigation into the pharmacology, chemistry and clinical value of endemic medicinal Australian plants has mostly been restricted to a small number of species of known commercial value including 'Eucalyptus' and 'Melaleuca' species. Informed by an ethnopharmacological approach, our research extends the range of species with potential therapeutic and commercial value and provides the basis for longer term government and private investment in partnership with Aboriginal communities in an emerging health care industry addressing the imperatives of a globalized market while providing employment opportunities for Aboriginal people in marginalized regional communities.

Background: Alcohol Management Plans (AMPs) were first implemented by the Queensland Government a decade ago (2002-03). In 2008, further stringent controls were implemented and alcohol was effectively prohibited in some of the affected remote Indigenous communities. With the Queensland Government currently reviewing AMPs, prohibitions may be lifted making alcohol readily available once more in these communities. As yet no work explores the impact of alcohol related injuries in relation to individual, family and community resilience in Indigenous Australians. A resilience model recognises individuals and families for their strengths rather than their deficits. By revealing how some individuals and families survive and thrive, new ways of working with families who need support may be identified and adopted. The research will explore in detail the long-term impact of this kind of injury on individuals, families and communities. Methods/design: This project will use a sequential explanatory mixed method design. Four discrete Indigenous communities in Cape York, far north Queensland are included in this program of research, chosen because there is previous data available regarding injury and alcohol related injuries. Four sequential studies will be conducted in order to address the research questions and provide a rich description of the impact of alcohol related injuries and resilience in these populations. The time period January 2006 to December 2011 was chosen because it captures the three years before and three years after 2008 when tight alcohol restrictions were implemented in the four communities. Discussion: Long term effects of the AMPs are as yet unknown and only fragmented attempts to look at the impact of injury related to alcohol have been conducted. A well-structured research program that explores the long-term impact of alcohol related injuries in these communities will help inform policy development to capture the current situation and so that appropriate benchmarking can occur. The project has been approved by the James Cook University Human Research Ethics Committee H5618 & H5241.

Background: Despite the well-recognised benefits of insulin therapy in Type 2 diabetes, research has shown that patients are hesitant to commence insulin therapy, a syndrome that is termed by researchers as psychological insulin resistance or PIR. PIR occurs on several levels, emotional; cognitive; behavioural; social and relational. Anecdotally, there is a high proportion of Torres Strait Islanders with poorly controlled diabetes who appear to refuse insulin treatment. Study Aims: This study will identify any potential psychological resistance factors, which are salient for Torres Strait Islanders living in the Torres Strait region who have poorly controlled diabetes, using validated instruments. Methods / Design: A descriptive cross sectional study using the "barriers to insulin treatment questionnaire" and the "insulin treatment appraisal scale" to measure barriers to insulin therapy. Sample Size: Of the 198 adults with diabetes in 5 remote Torres Strait communities, 67 (34%) have an HbA1c equal or greater than 8.5%. Of these 30 are eligible for this study (not currently receiving insulin). 30 respondents will give this study 80% power to detect a correlation coefficient of 27% or more, as a measure of agreement between the two scales. Discussion: Low rates in insulin therapy and self-monitoring in this high risk population needs to be investigated and addressed appropriately. PIR is potentially an important barrier to treatment escalation.

Indigenous populations have been recognised to have elevated rates of suicide in many countries around the world, including Australia. However, to date, comprehensive understanding of the complexities of suicides among persons of Aboriginal and/or Torres Strait Islander origin (in the report referred to as Indigenous populations or Indigenous Australians) has been limited due to scarce epidemiological evidence about its prevalence and specific factors that distinguish Indigenous suicides from those among non-Indigenous populations. This report aims to fill in this gap by providing an analysis of the incidence of suicide among the Indigenous population in Queensland, thereby increasing the understanding and awareness of the distinctive aspects of Indigenous suicide.

A review of Aboriginal suicide prevention programs were conducted to highlight promising projects and strategies. A content analysis of gray literature was conducted to identify interventions reported to have an impact in reducing suicidal rates and behaviors. Most programs targeted the whole community and were delivered through workshops, cultural activities, or creative outlets. Curriculums included suicide risk and protective factors, warning signs, and mental health. Many programs were poorly documented and evaluations did not include suicidal outcomes. Most evaluations considered process variables. Results from available outcome evaluations suggest that employing a whole of community approach and focusing on connectedness, belongingness and cultural heritage may be of benefit. Despite the challenges, there is a clear need to evaluate outcomes if prevention is to be progressed.

The impact of parental suicide on surviving children and their family system has received inadequate research attention. Using a qualitative narrative methodology with thematic analysis, we explored the short-term and lifelong impact of parental suicide among 10 adults who, as children or adolescents, had lost a parent through suicide. The suicide triggered a wide range of structural and relational changes to the family, resulting in a cascading series of negative outcomes. These systemic issues are discussed and recommendations made about support structures for bereaved children and their families. Limitations of the study are discussed and future research directions identified.

For more than a decade 'Australian Folklore' has featured reflective articles and reports concerned with food practices in this country, and, in view of receipt of more interesting notes and thoughts than usual in the last two years, these have been collected up together for this 'anniversary' issue. They are introduced by a pioneering article on celebrity chefs in the years when the accelerating changes in Australian taste again experienced a further great sea change. In the event, the shorter pieces make reflections on earlier styles that are still recalled and, perhaps, lamented for their passing.

In the aftermath of suicide, grief becomes a multi-faceted experience. Traditionally, this grief was silenced where the shame attached to suicide invalidated a person's need for expression. Even now, it can be difficult for people to fully articulate their grief, let alone find an empathetic audience. How do we examine this grief to more clearly hear the voices of the bereaved, and to better understand how to support those who are grieving a suicide death? Indeed, the ripple of suicide grief touches more than those traditionally considered to be impacted by the death. Whole communities can be affected and it cannot be presumed that researchers do not have their own lived experiences of suicide bereavement. In this way, the newly-opened discourse around the experience of suicide grief needs to be dissected within more practical and appropriate research. A balance needs to be created in research where the voices of grief can be included but the experiential context understood and respected.