Aboriginal And Torres Strait Islander Wellbeing Projects .
Aboriginal and Torres Strait Islanderwellbeing projects: Murray LLS wellbeingsurvey & Mayi KuwayuDr Ray Lovett, Research Fellow, Australian National UniversityJan Chapman, Centre for Health and Wellbeing Research, Australian Institute of Aboriginal and Torres Strait Islander StudiesDr Jacki Schirmer, Senior Research Fellow, University of CanberraDr Claire Colmean, Inaugural Senior Research Fellow, University of Sydney
Outline Murray Local Land Services survey– Wellbeing and caring for country– Connection to Regional Wellbeing Survey Broader Background and rationale––––Policy and research directionsWellbeing outcomes/Socio-cultural determinantsWhat is known?Mayi Kuwayu Methods and Conceptual framework Design– Community engagement– Questionnaire domains– Questionnaire development Outcomes
Background/rationale Connection to country and wellbeing Regional wellbeing survey Aboriginalparticipation Mayi Kuwayu project connections– Socio-cultural determinants of Aboriginal andTorres Strait Islander health and wellbeing
Broader policy and research directions National Aboriginal and Torres Strait IslanderHealth Plan 2013-2023– The Centrality of Culture and Wellbeing in the Healthof Aboriginal and Torres Strait Islander People: “Werepresent an evolving cultural spectrum inclusive oftraditional and contemporary practices. When we areempowered to do this, and where systems facilitatethis reclamation, protection and promotion, we arehealthy, well and successful and our communitiesthrive” Professor Ngiare Brown.
Research directions Cultural Determinants of Aboriginal and TorresStrait Islander Health Roundtable, November2014 (Lowitja Institute)1. Clarify what the cultural determinants ofAboriginal and Torres Strait Islander health are;2. Consider strategies that could assist instrengthening culture as a determinant ofAboriginal and Torres Strait Islander health;3. Caring for Country;
What is known?Australia: Self-assessed health by cultural factors, NATSISS 2008Source: Dockery, 2011 pp23
What is known?Healthy country, healthy people: the relationship betweenIndigenous health status and “caring for country”‘Greater participation in caring for country activities is associated with significantly betterhealth’.Source: Burgess et al, 2009.
What is known?Canada: Cultural Continuity as a Hedge Against Suicide in Canada’s First Nations(1998) Youth suicide by number of factors present in the communitySource: Chandler et al, 1998 pp 20
Proposed designMayi KuwayuMurray LLS Prospective cohort study Cross sectional study Repeated measures Community indicatordesigndevelopment (2 sites) Community indicator Use of existingdevelopment (15 sites)community Use of national databaseinfrastructure for& community orgs forrecruitmentrecrutiement
Mayi Kuwayu aims1.2.3.4.5.Develop appropriate cultural wellbeing indicators withAboriginal and Torres Strait Islander peopleQuantify prevalent cultural, health risk, health status andother factors, and their inter-relationships, among thestudy populationQuantify changes in cultural factors and health andwellbeing outcomes over timeInvestigate prospectively the relationship of cultural andhealth risk factors to health and wellbeing outcomes, andany mediating role of culture in risk factor-outcomerelationshipsCreate a collaborative resource for Aboriginal and TorresStrait Islander health research/action10
Mayi Kuwayu ‘determinants of thedeterminants’ approach Relationships with country/spirituality/rituals: (Assembly of First Nations,2002; Burgess, Berry, Gunthorpe, & Bailie, 2008; Ganesharajah, 2009;Knibb-Lamouche, 2012; Prout, 2011) Identity and identity representation/racism: (Chandler, 2003;Cunningham & Paradies, 2012; Fforde, Bamblett, Lovett, Gorringe, &Fogarty, 2013; Hallett, 2007; Henry, 2004; Paradies, Harris, & Anderson,2008; Reading, 2009; Zubrick et al., 2014) Heritage language: (Chandler, 2003; Hallett, 2007; Reading, 2009) Agency/self-determination/empowerment/fate control: (Arctic SocialIndicators (ASI) Working Group, 2010; Hallett, 2007; Knibb-Lamouche,2012; Reading, 2009; Taylor, 2012) Cultural continuity: (Assembly of First Nations, 2002; Chandler, 2003;Knibb-Lamouche, 2012; Reading, 2009)
Questionnaire domains & testingPilot studyRisk factorand healthissuesSociodemographicsLanguage ayuLeadershipandgovernanceHealth accessand treatmentMob andCountryIdentity andracism– Questionnaireacceptability and validity(core survey)– Consent for linkageRecruitment methods Community organisationrecruitment Medicare Paper, online electronic
Conceptual modelThe cultural landscape and Aboriginal experienceare likely to directly influence compositional andcontextual factors (such as education and housing),risk factors, health events, care, and/or health andwellbeing. Do people who have retained or revivedtraditional language have improved educationoutcomes? Does strong connection to country mean lowerrates of smoking? Do those with strong family ties experience alower burden of mental health problems afterexperiencing stressful life events? Or do these factors mediate the relationshipsbetween the layers?13
SamplingMayi KuwayuMurray LLS Sampling frame (registered with theMedicare 360,000 or 60% of thepopulation)Oversampling for areas withanticipated lower response rates(remote areas)Medicare Australia post studymaterials on behalf of theinvestigator team to (200,000 people)Complete survey in hard copy, onlineand phoneProvide consent for data linkage andfollow upAnticipated response: 24,000-36,000 Community org mailing listsCommunity org based recruitmentComplete Survey Tablet, online,phone, paperAnticipated response: 300Assumptions re mode of recruitment14
Timeline (Mayi Kuwayu)15
Data itemsVariableMeasureParticipant report of family/community environment at baseline and follow upDemographics28Age; sex; income; education; employment; financial benefitsFamily and relationships28Number of children; family/household structure; social capital.Identity; cultural knowledge and practice, cultural knowledge exchange; caring for country; community involvementCultural factorsand cohesion; racism;24,31 heritage language.HousingEnvironmental/housing conditions;28, 43 homelessness.Participant report of health issues and risk/protective behaviours at baseline and follow upOverall health of person and HealthSelf-rated health; disability; health conditions, other long term conditions; medications; operations; screening.conditions28, 41, 43-45Mental health and Wellbeing 28Diagnosed mental health conditions, age of diagnosed mental health condition 40; Kessler-5; Personal WellbeingIndex; quality of life.Tobacco, alcohol46Cardiometabolic factors28, 44Lifetime and current smoking behaviour; alcohol consumptionHeight; weight; physical activity; sedentary behaviours; fruit/veg intakeLife events, resilienceOccurrence of stressors1; resilience scale18; life events; violence, incarcerationHealth outcomes and exposures ascertained through data linkageHealth services useMBS consultations; hospitalisations; emergency department attendanceWide range, including: mortality, hospitalisation, cancer, emergency department presentations, medications forHealth outcomesspecific health problems16
Progress to dateMayi KuwayuMurray LLS Literature review Grants (NHMRC, Lowitja Institute) Proposed Study Governancegroup (AIATSIS, NACCHO, LowitjaInstitute, ANU) Community and Technical Panels Planning for 15 site workshops Development of statisticalcapacity building component Ethics (community workshops) Initial site meetings(Albury/Wodonga &Deniliquin) Swan Hill, Robinvale & Mildura(28-31 October 2014) Questionnaire workshops(January 2015 inAlbury/Wodonga andDeniliquin) Local org to partner inworkshoporganisation/facilitation Ethics: survey early 2016
Understanding wellbeing – what is proposed for the survey?Understand the role of community – people and place Geographic community–Is it a great place? A place people feel part of? A safe place? Aboriginal & Torres Strait Islander community–Sense of belonging, cohesion, being welcomed, being recognised as part of the community byother Aboriginal and Torres Strait IslandersWhat are your views about the community you live in?StronglyDISAGREEStronglyAGREEDon’tknow① ② ③ ④ ⑤ ⑥ ⑦⃝ ⃝ ⃝ ⃝⃝ ⃝ ⃝ ⃝⃝This community has a bright future⃝ ⃝ ⃝⃝ ⃝ ⃝I feel proud to live in this community⃝ ⃝ ⃝⃝ ⃝ ⃝ ⃝⃝There’s good community spirit around here⃝ ⃝ ⃝⃝ ⃝ ⃝ ⃝⃝I like the environment and surrounds I live in⃝ ⃝ ⃝ ⃝⃝ ⃝ ⃝ ⃝⃝This is a safe place to live⃝ ⃝ ⃝⃝ ⃝ ⃝There is a high crime rate in this community⃝ ⃝ ⃝⃝ ⃝ ⃝ ⃝⃝Many people in this community drink too much alcoholor misuse drugs⃝ ⃝ ⃝⃝ ⃝ ⃝ ⃝⃝My community is a great place to live⃝⃝
Understanding wellbeing – what is proposed for the survey?Culture and identity ‘Core’ culture and identity– Identifying with mob, country, relationship tocountry, following mother or father’s country,totems/dreaming, men and women’s businessDo you have special things youdo for making young men andwomen? (initiation)Has this happened to you?⃝ Unsure⃝ Prefer not to answer⃝ Yes⃝ No⃝ Prefer not to answer⃝ Yes⃝ No
Understanding wellbeing – what is proposed for the survey?Cultural knowledge and practice What cultural knowledge and practices do peopleengage in (food, medicine, law, special places,ceremony, art, music and more) Challenge – what is cultural knowledge?The next questions are about your culturalknowledge and practice. Answer based onhow you feel, rather than comparing yourselfto previous generations or others. To bepracticing culture, you don’t have to usetraditional methods – culture changes overtime, and it’s still cultural practice if you usemodern technology.
Understanding wellbeing – what is proposed for the survey?Caring for country Overall importance of caring for country compared to other things inthe community Living on, visiting and having responsibilities formother’s/father’s/other country How healthy is country at the moment? (water, soil, animals, plants,climate ) Types of on-country activity engaged in– How does engaging on country make people feel?– Does it enable social interaction (good or bad), exercise, improved health(people-country), cultural learning & practice, income earning Barriers to getting engaged in on-country activity– Physical (transport, health), social (being welcome), confidence inskills/knowledge, legal (permission/permits)
Yes, oncountry Icurrentlylive onYes, ��⃝Caring for native vegetation⃝⃝⃝⃝Reducing erosion⃝⃝⃝⃝Protecting native ⃝⃝⃝⃝⃝⃝⃝⃝⃝Canoe building⃝⃝⃝⃝Tool making⃝⃝⃝⃝Collecting seeds, storing seeds⃝⃝⃝⃝Learn about, use bush �⃝⃝Would you like to be involved in caring forcountry in any of the ways listed below in thefuture?EnvironmentUnderstandingwellbeing – what isproposed for thesurvey?Caring for countryinto the futureImproving river health, protecting riverbanksGetting rid of weedsControlling feral animals (e.g. foxes,cats, pigs, rabbits)Protecting wetlandsRecognising historyCultureArts andtraditionalskillsFood andmedicineIdentifying massacre sites andprotecting themIdentifying, protecting sites wherepeople were removed from countryProtecting Aboriginal artefactsProtecting cultural sitesPassing on culture to others incommunity e.g. songlinesCeremony (e.g. smoking ceremony,dancing, music)Gathering fibres, weavingLearn about, collect, eat traditionalfoodsEarn income from countrySelling goods produced from countrye.g. crafts, foods
Understanding wellbeing – what is proposed for the survey?Health & wellbeing Using several commonly used measures to enablecomparisons K5, general health, life satisfaction, self-efficacy Alcohol, smoking, diagnosed health issues
Understanding wellbeing – what is proposed for the survey?Language Use of Aboriginal/Torres Strait Islander language– Own– Family– Community Confidence and feeling associated with use oflanguage
Understanding wellbeing – what is proposed for the survey?Racism Yin Paridies – Mirequestions Frequency ofPlease indicate how much you disagree or agree withexperienceeach of the following statements. There are no right orwrong answers. Response Internalising/ I feel accepted by other Indigenous peopleIndigenous people have less opportunities than othervaluesAustraliansStrongly Disagree Neither Agree Stronglydisagreeagree enous people should try to think and act more likeother Australians⃝⃝⃝⃝⃝I feel good about being an Indigenous person⃝⃝⃝⃝⃝Other Australians think that Indigenous people are betteroff because they get special treatment from thegovernment⃝⃝⃝⃝⃝Other Australians think they are better than Indigenouspeople⃝⃝⃝⃝⃝There is hardly ever anything good about Indigenouspeople in the media (TV, radio, newspapers, etc.)⃝⃝⃝⃝⃝I often witness racism⃝⃝⃝⃝⃝
Understanding wellbeing – what is proposed for the survey?Involvement in & leadership of local community Aboriginal and Torres StraitIslander community Non-Aboriginal and Torres StraitIslander community Leadership & collaboration incommunityStronglyDISAGREE① ② ③There are people I can go to in my community if there isa problem⃝⃝⃝Local Aboriginal groups and organisations around hereare good at getting things done⃝⃝⃝The local Aboriginal community copes pretty well whenfaced with challenges⃝⃝⃝There are places in this community where it is easy forAboriginal people to come together and meet⃝⃝⃝The people who make decisions for the local Aboriginalcommunity represent the whole community, not justpart of it⃝⃝⃝I can get involved in local Aboriginal communitydiscussions if I want to⃝⃝⃝Community leaders around here are able to geteveryone working together⃝⃝⃝I trust the people who act as leaders in my localAboriginal community⃝⃝⃝I am listened to by others in the community if I want tospeak up⃝⃝⃝There are respected Elders with cultural knowledge I cango to⃝⃝⃝
Understanding wellbeing – what is proposed for the survey?Family and carers Family connection, relationships and coping Type of carers experienced growing upUnderstanding wellbeing – what is proposed for the survey?Family member removals and the Stolen Generation Experience of removals and Stolen Generation Self and others in family
Understanding wellbeing – what is proposed for the survey?Sociodemographics Gender, ageLGBTIGeographic locationMarital statusHousehold compositionEmployment, studying, caring responsibilitiesEducational attainmentIncome and self-rated financial prosperity
Challenges/expectations Distance Multiple ethics approvalprocesses/stages Community navigation/Communitypriorities Ownership/custodianship of data andresults Timeframes for consultation
Potential outcomes Prevalence Reliable data on:––––Cultural determinantsCulturally valid measures of wellbeingAssociations: culture and wellbeingCaring for country priorities Correlation between policy/programimplementation and outcomes Empowered communities Information we currently don’t have
lemena@Sydney.edu.au
A world in which all Indigenous peoples’knowledge and cultures are recognised,respected and valued.
Aboriginal & Torres Strait Islander community – Sense of belonging, cohesion, being welcomed, being recognised as part of the community by other Aboriginal and Torres Strait Islanders Understanding wellbeing – what is proposed for the survey? Understand the role of community – people and place
Strait Islander Child Placement Principle: A resource for legislation, policy and program development; and Baseline Analysis of Best Practice Implementation of the Aboriginal and Torres Strait Islander Child Placement Principle.1 Across Australia, a significant number of Aboriginal and Torres Strait Islander agencies support children
Understanding culture 20 Core principles 22 Protocols for culturally respectful engagement with Aboriginal and Torres Strait Islander people 25 Describing Aboriginal and Torres Strait Islander people 25 Deceased people 25 A death in a community 25 Permission: for what, w
Aboriginal place names Invite an Indigenous artist to paint a mural Study Aboriginal or Torres Strait Islander arts and crafts Make your own Aboriginal or Torres Strait Islander art Read a dreamtime story Start your own Indigenous Hall of Fame featuring any local role models and achievers
Aboriginal and Torres Strait Islander people in custodial care. A justice reinvestment programme for detainees should be introduced as a cost-effective way to reduce the risk of reoffending and minimise future custodial care outlays. It also could be extended to more youth mental health services in Aboriginal and Torres Strait Islander
Chapter 5 explores various issues around identifying talented Aboriginal and Torres Strait Islander students, while Chapter 6 identifies key issues relating to classroom management. These issues are set within a school case study, based in Cairns. Chapter 7 articulates an explicit approach to teaching reading to Aboriginal and Torres
young Aboriginal and Torres Strait Islander people with severe and complex mental health needs. 1.2 Study aim and objectives This project aimed to identify and document promising practice approaches to improve the SEWB among young Aboriginal and Torres Strait Islander people with severe and complex mental health needs.
Education action plan sets out the Government's priorities for improving the early childhood and school education outcomes for Aboriginal and Torres Strait Islander children and students in Queensland. This plan focuses and enhances the Department of Education's efforts to close the gap, and will be enacted in
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