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The intent of this action is to build effective and ongoing relationships with Aboriginal and Torres Strait Islander communities, organisations and groups that represent or service this population. This will enable the health service organisation to identify priorities, understand cultural beliefs and practices, and involve Aboriginal and Torres Strait Islander people in determining their own health priorities. When Aboriginal and Torres Strait Islander people are marginalised and not engaged in decision-making, the result is ineffective use of resources, both human and financial, with limited improvement in outcomes. For the health service organisation to move beyond tokenistic relationships and towards working in true partnership requires meaningful engagement and understanding, with a commitment to building mutually beneficial relationships. There is evidence across Australia that Aboriginal and Torres Strait Islander people have limited access to appropriate services.7The health service organisation should work in partnership with communities to improve access to care, especially for individuals who need to access available services but do not currently do so. To better understand Aboriginal and Torres Strait Islander communities and build effective relationships, health service organisations could work with Aboriginal community controlled health services, Aboriginal Land Council or other Aboriginal and Torres Strait Islander groups that are working effectively with local communities. Working in partnership with Aboriginal and Torres Strait Islander communities to bring about change is likely to succeed if the following cultural principles are understood and observed: Benefits for the health service organisation include: Benefits for the Aboriginal and Torres Strait Islander community include:
Planning and delivering services to Aboriginal and Torres Strait Islander children, families, and communities can be a complex task for practitioners and policy-makers. Social problems are often deeply entrenched, and need to be approached with consideration of historical, social, community, family and individual factors. Furthermore, as Australian Indigenous cultures are not homogenous, Indigenous communities can differ considerably. Indigenous communities often have characteristics specific to geographic location, with significant variation evident across urban, rural, and remote communities (Neckowaya, Brownleea, & Castellana, n.d.). Methods that child and family services can use to support Indigenous families and communities include:
Many Indigenous families and communities in contemporary Australia face immense challenges. Their strength and resilience is compromised by multiple complex problems, including historical and ongoing dispossession, marginalisation, and racism, as well as the legacy of past policies of forced removal and cultural assimilation (Human Rights and Equal Opportunity Commission, 1997). These issues contribute to the high levels of poverty, unemployment, violence, and substance abuse seen in many Indigenous communities. They also impact negatively on Indigenous children, who demonstrate poor health, educational, and social outcomes when compared to non-Indigenous children (Australian Institute of Health and Welfare [AIHW], 2009). Additionally, there is a number of factors that inhibit the successful delivery of services to Indigenous families and communities. A lack of appropriate infrastructure can hinder the logistics of service delivery. Demanding workloads and low remuneration make staff burnout a common issue. Difficult social environments - with low levels of trust, participation, social control, and efficacy, and high levels of anxiety, disempowerment, disorganisation, and mobility - provide the context for much service delivery. Finally, evidence regarding effective responses to problems in Indigenous communities is limited (Scougall, 2008). Despite the complexity of these issues, there are services that are working effectively to reduce Indigenous disadvantage in Australia (Flaxman, Muir, & Oprea, 2009; Scougall, 2008). The lessons learnt from these services about what works are critical to ensuring improved outcomes for Indigenous children, families and communities. The impetus to deliver improved outcomes for Indigenous children, families and communities is strengthened by the Council of Australian Governments' (COAG) Indigenous reform agenda (2010), referred to as "Closing the Gap". This reform agenda aims to "close the gap" on Indigenous disadvantage across 6 key areas - life expectency, child mortality, access to early childhood education, literacy and numeracy, education attainment, and economic partcipation (COAG, 2010). This Practice Sheet summarises those lessons and is likely to be of most use to organisations, services, agencies and program/project managers who are planning or delivering Indigenous-specific services, or who are operating in areas where there are large numbers of Indigenous service users. For more information about research evidence on what works to close the gap on Indigenous disadvantage, visit the Closing the Gap clearinghouse Practice considerationsPractice considerations are general principles based upon lessons from research and practice designed to provide additional guidance to service providers about specific issues relating to children and families, especially as they relate to disadvantaged Australian communities. The following practice considerations are elaborated upon using case studies. What methods can child and family services use to support Indigenous families and communities?Work with Indigenous communitiesI approached the Elders and involved them ... And they become part of it and they'd say, "We'd like to sit on your advisory [board]". And in the Aboriginal community, if we're doing a good job, then everybody knows about it. (Indigenous service provider, as cited in Higgins & Butler, 2007, p. 11) In the past, some service providers have been criticised for not involving the community in service delivery. Services for Indigenous Australians are most effective when the community is involved in both their planning and implementation stages. When Indigenous Elders, community members, and other local service providers are engaged in a consultative process, the most important needs of the community can be distinguished and the most appropriate methods of implementation can be identified. Working with (rather than working "on") Indigenous communities can be achieved when service providers adopt the following principles:
For more information on working with Indigenous communities see Scougall (2008, pp. 66-67) and Higgins (2004). Ensure that your service is culturally competentWhen I was 9, I was in a really bad place. Experiencing all that I had, I felt like I had lost my soul. I still remember the day I arrived at the agency, it was a lot for me 'cause I had only had some bad experiences with white fellas before. But there was a Koorie Flag on the wall and a plaque saying your office was on Wurrundjeri land and even though I'm Yorta Yorta I thought maybe, just maybe, it would be different. (Indigenous service user, as cited in Victorian Aboriginal Child Care Agency, 2008, p. 52) Indigenous Australians have maintained cultures that are in many ways distinct from that of mainstream, non-Indigenous Australia. This cultural difference has implications for both policy and practice. If services do not adapt to the contemporary Indigenous cultural context, they have little chance of improving outcomes in the long term. To be culturally competent, service organisations need to ensure that cultural knowledge shapes (1) the structure of the service; (2) the specific practices and strategies employed; and (3) the selection, training, and actions of individual staff members (as discussed in the section "Focus on attracting and retaining the right staff"). The following tips on culturally competent service structure and culturally competent practices and strategies will help ensure cultural competence. Culturally competent service structure
Culturally competent practices and strategies
For more information on Indigenous cultural competence see Flaxman et al. (2009, pp. 23-28) and the Victorian Aboriginal Child Care Agency (2008). Focus on attracting and retaining the right staffWhat makes it work is people. The staff have expectations of themselves and of colleagues. They're self-managing. The quality assurance [of the program] comes from the staff. (Indigenous service provider, as cited in Higgins & Butler, 2007, p. 13) Competent and capable staff members are key to the success of any social service delivery. This is especially true for Indigenous-specific services, where success is often largely dependent on cultural competence and the development of trusting relationships with the community. A strong team in an Indigenous-specific service will have staff who have the following characteristics:
For more information on attracting and retraining the right staff when working with Indigenous communities see Scougall (2008, pp. 53-55) and Flaxman et al. (2009, pp. 28-30) Cultivate networks and relationshipsWorking in partnership with a wide range of local services has been integral to the success of the Project. (Indigenous Project Progress Report, as cited in Scougall, 2008, p. 62) Research strongly suggests that services working in isolation often struggle to meet the complex needs of vulnerable and at-risk families (e.g., Indigenous families). Services that form partnerships and collaborations with other local community and government organisations are better able to ensure that those in need receive the right assistance. Some examples of organisations with which Indigenous-specific services have collaborated are:
For more information on collaboration with Indigenous-specific services see Scougall (2008, pp. 60-62) and Soriano, Clark, and Wise (2008). Adopt an action research approachOur critical community of action researchers working together, reflecting, sharing, and thinking includes the Yolngu elders, the Yolngu action group, Balanda [non-Indigenous] teachers, and a Balanda researcher to help with the process. Of course, she [the researcher] is involved too; she cares about our problems, she has a stake in finding solutions - this too is different from the traditional role of a researcher. (Mandawuy Yunupingu, then head of the Yirrkala Ganma Education Project, as cited in Denzin & Lincoln, 2005, p. 584) Action research is a participatory group process aimed at continual evaluation and improvement of practice. It helps to tailor projects to local environments and situations. An action research approach may be useful to services during the planning phase of a program. It has been noted that there is compatibility between action research methods and traditional Indigenous cultural practices and ways of working. Action research involves a dynamic and cyclical process of planning, acting, observing, and reflecting:
For more information on the action research approach, see Scougall (2008, pp. 62-65) and Lienert (2002a, 2002b). There are many examples within CAFCA's Promising Practice Profile database of promising and innovative methods that have been used by services and programs to support Indigenous families and communities. For example, one program delivers locally inclusive and culturally respectful pregnancy and parenting education for young people, especially those in rural and remote Indigenous communities. The program was developed in response to community and school-based requests. Community members are involved in each step of the planning and administration of the program. This involves:
Another service, an early intervention program for at-risk young people between the ages of 12 and 17, consists of intensive weekend camps and follow-up support groups; 30% of their clients are Indigenous. At the camps, young people can talk through issues that are affecting their lives and learn how to more effectively handle them. The Program's innovative staff structure includes three key roles:
References
Acknowledgements
Rhys Price-Robertson is a Research Officer with the National Child Protection Clearinghouse. Myfanwy McDonald is a Senior Research Officer with the Communities and Families Clearinghouse Australia. The authors acknowledge the valuable assistance and feedback of Leah Bromfield, Daryl Higgins, and Jacqui Stewart of the Australian Insitute of Family Studies. The authors also acknowledge the valuable contribution of Peter Lewis and Muriel Bamblett of the Victorian Aboriginal Child Care Agency (VACCA). |