Best Practice and Good News Stories: 2012-13 AMA Indigenous Health Report Card - "The Healthy Early Years - Getting the Right Start in Life"

The Darwin MGP was developed as a continuity of care model to better address the care and support needs of Aboriginal and Torres Strait Islander women living in remote areas of the Northern Territory who are transferred away from family and community to regional centres in the weeks before labour and delivery. This can have significant psychosocial and family impacts – particularly for young women where this may be their first separation from family and community.  Language and cultural differences can present challenges in negotiating travel and hospital systems, understanding of health information and arranging post-discharge care plans.

The Darwin MGP service operates a caseload model in partnership with community-based midwives in seven ‘top-end’ remote NT communities. Antenatal care is provided by remote health staff and communication with the MGP by telephone and via an electronic medical record system.  The MGP midwife and/or Aboriginal health worker meets and accompanies the woman to any visit in Darwin for medical, ultrasound or other health appointments. Transfer from a remote community to Darwin is arranged at 38 weeks gestation (earlier if medically necessary). At all stages, and for all women, partnership with Indigenous staff is designed to respect and engender the feeling of cultural security and safety. MGP staff members encourage and facilitate education and each woman’s familiarisation with the hospital birthing facilities. An MGP staff member attends the birth, whether in the birth centre delivery suite or the operating theatre.  The program also supports post-natal care, education and support for the woman and baby until they return to their community where the post-natal care is then coordinated by the community-based midwife.

Aboriginal Family Birthing Program (AFBP) South Australia

COAG funding has been used to support the establishment of the AFBP across urban, regional and remote areas of South Australia. These services enable women to be cared for during pregnancy and birth by an Aboriginal Maternal Infant Care Worker in partnership with public hospital midwives and doctors. Preliminary findings suggest that the shift to providing services for Aboriginal families via the AFBP has improved engagement with antenatal care, timing and number of visits. Aboriginal women were very positive about the care that they received from Aboriginal Maternal Infant Care Workers, and from midwives and doctors in the AFBP services. These promising early results are likely to translate into improved outcomes for Aboriginal women and children.

Abecedarian Approach to Early Childhood Development

The Abecedarian approach is a suite of high-quality teaching and learning strategies to improve the later-life outcomes of children from at-risk and under-resourced families. The Abecedarian approach has three key elements:

• Learning Games - a set of game-like activities between an adult and child that are integrated into the routines of caregiving and play;
• Conversational Reading – based on the idea of ‘joint attention’ where children are read to each day by adults;
• Language Priority – where parents and educators emphasise language throughout daily events and routines, engage in extended conversations and respond to children’s use of language.

The Abecedarian approach is based on the idea of ‘enriched caregiving’, where care for a child is seen as involving a range of things, including cognitive and educational enrichment. These elements have been successfully implemented in a range of service delivery settings, including home-visiting; parent education classes; family child care homes; child care centres; kindergarten classes, and family literacy programs.

The outcomes of the Abecedarian approach have been consistently positive in all contexts in which it has been implemented. For example, studies have shown that:

• children in the normal IQ range who receive the Abecedarian intervention are more likely to maintain their normal IQ as they age, compared to those who do not receive it;
• at-risk children who do not receive the Abecedarian program in the first five years of life are twice as likely to be placed in special education for one or more years by the time they are aged 15;
• low birth-weight babies who received the intervention have higher maths achievement, higher receptive vocabulary, and fewer risk-taking behaviours at age 18, compared to those low birth-weight babies who did not receive it;
• at age 21, 70 per cent of those who had received the Abecedarian intervention in infancy or pre-school years were in higher education or a skilled job, compared to 40 per cent who had not received the intervention; and
• benefits also accrue for the mothers of children who receive the intervention, including teen mothers who are more likely to continue on to post-secondary education than teen mothers who do not participate in the Abecedarian intervention (80 per cent compared to 30 per cent).

There are strong examples of the Abecedarian approach operating with Aboriginal and Torres Strait Islander children, including at the Central Australian Aboriginal Congress (below), and the Gumala Early Childhood 3A (Abecedarian Approach Australia) Project.

The AMA believes that the Abecedarian approach has a very strong track-record of success in protecting against some of the significant adverse later-life outcomes of a poor start to life. Australian governments must focus more on this success, and target resources to support its widespread implementation for Aboriginal and Torres Strait Islander families in need.

The Central Australian Aboriginal Congress – Prevention and Early Intervention Programs

The Central Australian Aboriginal Congress in Alice Springs (‘Congress’) has pioneered the extension of its Aboriginal and Torres Strait Islander primary care services by incorporating a coordinated set of early intervention and preventive programs targeting early childhood. These show promising early results and include:

• the Australian Nursing Family Partnership Program (ANFPP);
• the Healthy Kids Clinic (HKC) - routine comprehensive child health checks for all children aged 0-5 years and maintains immunisation schedules;
• Targeted Family Support Services (TFSS) and Intensive Family Support (IFS) working with at-risk children and families;
• the Child Health Outreach Program (CHOP) providing intensive support for children to age 12 with chronic health conditions and social barriers to accessing services;
• the Multifunctional Aboriginal Children (MAC) Long Day Care Facility co-located with the primary health service, and
• the Congress Preschool Readiness Program – which has the goal of closing the wellbeing gap for Aboriginal children by age five.

The co-location of these programs enables useful synergies in identifying and addressing cumulative health and psychosocial issues impacting on development and early learning. More details can be found at Prevention and Early Intervention Programs.

Gujaga Multifunctional Aboriginal Children’s Service (MACS) in La Perouse, NSW, & Noogaleek (MACS) in Wollongong, NSW

Gujaga MACS is a transition to school program which works with local schools to offer a series of structured school orientation sessions for their preschool aged children. Often accompanied by family members, children are introduced to the school staff, environment, new rules and structures before they begin school the following year. Children are often ‘buddied up’ with primary school children, and participate in classroom activities, meet the Principal and other school staff, and explore the school. Gujaga staff take photos of the children in different parts of the school – such as the playground, library, classrooms, and with their new teacher. These are then put into a transition booklet for each child, which also contains the new school rules, the child’s reflections on their visit/s, and photos of their friends who will also be going to the same school. These booklets form a valuable resource to help familiarise children and their families with school and prepare them for the upcoming transition.

Noogaleek MACS delivers a year-long transition program in the year prior to school. The program focuses on three aspects; an intentional, structured school readiness teaching program; individual case management to address any health or developmental issues a child may have; and a series of school orientation visits. The service also works to support families through the transition, assisting with school paperwork and providing a supporting bridge to initiate and foster the relationship between the school and family. This is particularly important for Aboriginal and Torres Strait Islander families who may feel anxiety about school due to their own negative experiences, and who therefore need targeted support to develop trust and feel welcome within a school environment. The approach focuses on looking at each child in the context of his or her family and removing any potential obstacle that could hinder children successfully beginning school. Critical also is instilling in children a love of learning, a positive association with school, and a high sense of self-esteem and identity.

Echuca East Primary SchoolVictoria

Echuca East Primary School works with its Koorie Engagement Support Officer, local Aboriginal elders, families and community to provide a holistic approach to transition to school. The transition program is fully embedded within the school, and led by the school’s Leadership Team, including the Assistant Principal and the Koorie Engagement Support Officer. Transition is viewed as a shared school and community issue, and the Leadership Team works with local early childhood educators and families to ensure that they have a thorough understanding of each child coming in to the school. This information then provides an individualised, positive transition process for each child.

The New South Wales Intensive Family Support Service (IFSS)

The New South Wales IFSS provides intensive, in-home crisis intervention, practical assistance, counselling, skill development in parenting, along with regular monitoring. The IFFS provides family preservation services to reduce the need for out-of-home care for children at risk of entering care but assessed as not at imminent risk. The introduction of this service extended the spectrum of NSW family prevention and early intervention services to better address varying levels of family support needs.

Tyerrtye Arntarnte-Areme Service

The Central Australian Aboriginal Congress (CAAC) in Alice Springs provides two family support programs. The first program, provided through its Targeted Family Support Service, aims to prevent children becoming at-risk for future involvement with the child protection system.  The second program, the Intensive Family Support Service, works with families with a need for higher levels of support to ensure that children aged 0–12 years have their physical and emotional needs met, receive the care and supervision they need to remain safe and happy, receive the right medical treatment when needed, and have access to education and other learning environments.