What works to overcome Indigenous disadvantage

This section provides a summary of the Clearinghouse findings about what works for each of the COAG building blocks, as well as findings that apply across the building blocks. These summaries were drawn from Clearinghouse publications relevant to each building block.

 

Early childhood

Early childhood

What works

  • High-quality, holistic and early intervention and education. These can improve children’s lifelong outcomes across all areas—for example, education, health and wellbeing (both mental and physical).
  • Teacher training. Appropriate teacher training and support contributes to the uptake of early learning programs by Indigenous families (CtGC 2012a).
  • In the area of early childhood education Indigenous specific programs in early childhood education, supported playgroups and school transition programs offered the most promise for promoting change in the early learning and development of Indigenous children, and in helping to children for school (Bowes & Grace 2014).
  • Locally based early childhood development initiatives comprise multiple programs and services that are responsive to local context, culture, priorities, needs and strengths and build on the core expertise and capacity of different organisations. The processes of localised early childhood development emphasise Indigenous leadership and involvement in governance, action planning and program delivery and prioritise community capacity building (Wise 2013).
Cultural safety
  • Early childhood education was more effective, particularly for vulnerable families, when it took into account the contexts in which families live. Services were more effective for Indigenous children and families when they are aware of and address cultural competence and cultural safety in their service delivery (Sims 2011).
  • Cultural competence and cultural safety. These are an integral part of effective service delivery. Cultural competence is manifested by employing Indigenous workers, culturally aware non-Indigenous staff, emphasising strengths and empowerment and honest engagement, building trust and working with community members (Sims 2011; Harrison et al. 2012).
Family and community involvement
  • Community involvement was found to be particularly important to the success of early childhood programs. This involvement was needed in the planning and development of programs, not just the implementation (Sims 2011; Harrison et al. 2012).
  • Involvement of families. Effective programs provide a role for families as a support for their children, a welcoming environment for family members, and mechanisms for two-way communication with families (CtGC 2012a; Sims 2011; Harrison et al. 2012).
Improving access
  • Providing culturally secure services which honour and incorporate Indigenous childrearing and other practices.
  • Providing cultural training for non-Indigenous workers.
  • Providing continuity by engaging with parents from pregnancy onwards.
  • Continuity of services and engagement with families from pre-pregnancy through to middle childhood within the one agency or location.
  • Providing services in a friendly setting, close to where Indigenous clients live and conduct their daily activities.
  • Having a staff member within an agency who advocates for and promotes a program across one or more service providers.
  • Long-term, stable funding and delivering long-term programs.
  • Employing both Indigenous and non-Indigenous staff.
  • Offering the choice of Indigenous-specific and mainstream services (Ware V-A 2012).

References

Bowes J & Grace R 2014. Review of early childhood parenting, education and health intervention programsfor Indigenous children and families in Australia. Issues paper no. 8. Produced for the Closing the Gap Clearinghouse. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies.

CtGC (Closing the Gap Clearinghouse (AIHW, AIFS)) 2012a. What works to overcome Indigenous disadvantage: key learnings and gaps in the evidence 2010-11. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 69. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/
what_works_to_overcome_disadvantage_2010-11.pdf
>

Dockett S, Perry B & Kearney E 2010. School readiness: what does it mean for Indigenous children, families, schools and communities? Issues paper no. 2. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 36.Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctg-ip02.pdf>

Harrison LJ, Goldfeld S, Metcalfe E & Moore T 2012. Early learning programs that promote children’s developmental and educational outcomes. Resource sheet no. 15. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 76. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs15.pdf>

Sims M 2011. Early childhood and education services for Indigenous children prior to starting school. Resource sheet no. 7. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 55. Canberra: Australian Institute of Health and Welfare & Melbourne. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2011/ctgc-rs07.pdf>

Ware V-A 2012. Improving access to urban and regional early childhood services. Resource sheet no. 17. Produced for the Closing the Gap Clearinghouse. Cat. no. IHW 78. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs17.pdf>

Wise S 2013. Improving the early life outcomes of Indigenous children: implementing early childhood development at the local level. Issues paper no. 6. Produced for the Closing the Gap
Clearinghouse. Cat. no. IHW 112. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-ip06.pdf>

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Schooling

Schooling

What works

School readiness
  • Effective interagency partnerships, for example, positive professional links and regular communication between prior-to-school educators and school educators support children’s transition to school.
  • Education practitioners and policy makers need to be well versed in the importance of cultural factors in schooling and development of policies and programs that take account of Indigenous cultures and history should continue. Schools that employ and value Indigenous staff provide ‘ready’ links between school, families and communities, which can enhance the transition to school for Indigenous children.
  • Positive involvement of families and engagement with other community members in Indigenous children’s transition to school are important components of making a school ‘ready’.
  • High-quality early-childhood education helps prepare children for school (Dockett et al. 2010; Purdie & Buckley 2010)
School completion
  • School cultures and leadership that acknowledges and supports Indigenous students and families, including:
    • a shared vision for the school community
    • high expectations of success for both staff and students
    • a learning environment that is responsive to individual needs
    • a drive for continuous improvement
    • involvement of the Indigenous community in planning and providing education.
  • School-wide strategies that work to maintain student engagement and improve learning outcomes, including:
    • broad curriculum provision
    • quality vocational education and training (VET) options
    • school absenteeism and attendance programs
    • quality career education.
  • Student-focused strategies are also needed. These should directly meet the needs of students at risk of low achievement or early leaving, including:
    • targeted skill development
    • mentoring
    • school engagement programs
    • welfare support (Helme & Lamb 2011).
Teachers and school leaders
  • Teachers and school leaders were most effective when they were:
    • contextually literate (understand the broader environment)
    • organisationally savvy (organise their schools to respond to this environment)
    • leadership smart (act with others, focus on areas where they can make a difference, make changes based on evidence, make sure all changes are heading in the same direction, use a range of leadership styles and develop leadership in others).
  • Teachers and school leaders achieve positive educational outcomes when they act independently, are community-minded, supportive of differences and have a capacity for change.
  • Schools work better when they operate as flexible organisations that focus on developing networks, trust and resources (social capital) at three levels:
    • within the school as a community of professional learners
    • between schools
    • between the school and its community (Mulford 2011).
School-based health education
  • Positive health outcomes can be achieved when health education programs are:
    • delivered and assessed within the context of the core school curriculum
    • provided by trained and well-resourced classroom teachers
    • implemented across a substantial time frame and through at least two Health Promoting Schools dimensions
    • informed by local health issues, values and beliefs of individual students and their community
    • delivered within the context of safe and supportive classroom and school environments
    • underpinned by positive partnerships with parents, community members and health professionals
    • designed and evaluated according to sound health and educational theory and practice (McCuaig & Nelson 2012).
References

Dockett S, Perry B & Kearney E 2010. School readiness: what does it mean for Indigenous children, families, schools and communities? Issues paper no. 2. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 36.Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies.  <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctg-ip02.pdf>

Helme S & Lamb S 2011. Closing the school completion gap for Indigenous students. Resource sheet no. 6. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 38. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2011/ctgc-rs06.pdf>

McCuaig L & Nelson A 2012. Engaging Indigenous students through school-based health education. Resource sheet no. 12. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 67. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs12.pdf>

Mulford B 2011. Teacher and school leader quality and sustainability. Resource sheet no. 5. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 39. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2011/ctgc-rs05.pdf>

Purdie N & Buckley S 2010. School attendance and retention of Indigenous Australian students. Issues paper no. 1. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 33. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctg-ip01.pdf>

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Health

Health

What works

Tobacco
  • The evidence showed the following programs were effective:
    • health professionals providing brief advice on how to quit, when delivered with pharmacotherapy such as nicotine replacement
    • training health professionals to deliver cessation advice
    • quit groups
    • well-delivered multicomponent anti-tobacco programs (Ivers 2011).
Alcohol and other drugs
  • There was good evidence that indicated the following strategies used in relation to alcohol and other drugs were successful:
    • supply reduction strategies, including price controls, restrictions on trading hours, fewer alcohol outlets, dry community declarations, substitution of Opal fuel for unleaded petrol, and culturally sensitive enforcement of existing laws
    • demand reduction strategies, including early intervention, provision of alternatives to drug and alcohol use, various treatment modalities, and ongoing care to reduce relapse rates
    • harm reduction strategies, including provision of community patrols, sobering-up shelters, and needle and syringe exchange programs (Gray & Wilkes 2010).
Healthy lifestyle programs
  • In the Indigenous context, the community managed and initiated all the programs that were shown to be effective.
  • Individual, family-based and group-based Indigenous lifestyle programs had positive health effects for periods of up to two years.
  • Intensive lifestyle programs have been shown to be effective in reducing the incidence of diabetes developing among overweight non-Indigenous people with pre-diabetes (CtGC 2012b).
Sexual health
  • International evidence shows that sexual health education can lead to delayed initiation of sex and increased condom use among young people.
  • The best interventions are those based on a sound understanding of the behaviours, knowledge, beliefs and practices that they are trying to influence.
  • There is some Australian evidence that sexual health education programs can increase knowledge and change attitudes to STIs and BBVs, but only a small amount of evidence shows changes in behaviour.
  • In the Indigenous context, there is evidence that a multifaceted approach that includes community education and health promotion reduces rates of STIs.
  • A well-trained and well-resourced workforce to implement sexual health education programs in the community, clinical and school settings is paramount to their successful implementation and maintenance (Strobel & Ward 2012).
Suicide and suicidal behaviour
  • Community programs that focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing can be effective in preventing suicide.
  • A culturally adapted brief intervention comprising motivational care planning, has been effective in improving wellbeing and decreasing alcohol and cannabis dependence among Indigenous people with chronic mental illness, in three remote communities in northern Australia (CtGC 2013a).
Social and emotional wellbeing
  • The cultural healing programs Family Wellbeing, We Al-li and Marumali were effective in helping individuals work through their own issues and exert greater control over their own social and emotional wellbeing.
  • The process evaluation of the Social and Emotional Wellbeing Program (previously the Bringing Them Home Program) found it delivered counselling to a large number of individuals, families and communities who would otherwise have been unlikely to have received such services. Clients were typically satisfied with the program, but the quality of the service varied across locations.
  • Motivational care planning improved the mental health and decreased the substance dependence of Indigenous people with a mental illness in remote communities.
  • A culturally appropriate model of mental health service provision was successful in engaging Indigenous young people. Indigenous hip hop programs increased young people’s self-esteem, their preparedness to talk to family and friends about their own mental health issues and their ability to identify signs of depression in others.
  • Adaptations of effective mainstream programs—the Triple P-Positive Parenting Program, the Resourceful Adolescent Program and MindMatters—were considered culturally competent and achieved positive outcomes with Indigenous Australians (CtGC 2013b).
Social and economic determinants of health (educational attainment; connection to family, community, culture and country; employment and income; housing; racism; interaction with government systems and health behaviours)
  • Holistic approaches which work with Indigenous people in ways which take into account the full cultural, social, emotional and economic context of their lives, including an awareness of the ongoing legacy of trauma, grief and loss associated with colonisation.
  • Active involvement of Indigenous communities in every stage of program development and delivery, in order to build genuine, collaborative and sustainable partnerships with Indigenous peoples, and build capacity within Indigenous communities.
  • Collaborative working relationships between government agencies and other relevant organisations in delivering services and programs, acknowledging the interrelatedness of key social and economic determinants across multiple life domains for Indigenous Australians.
  • Valuing Indigenous knowledge and cultural beliefs and practices which are important for promoting positive cultural identity and social and emotional wellbeing for Indigenous Australians.
  • Clear leadership and governance for programs, initiatives and interventions. This includes commitment from high level leadership of relevant organisations and agencies to the aims of reducing Indigenous disadvantage and addressing determinants of health and wellbeing.
  • Employing Indigenous staff and involving them fully in program design, delivery and evaluation, and providing adequate training, where necessary, to build capacity of Indigenous staff.
  • Developing committed, skilled staff (Indigenous and non-Indigenous) and providing diversity and cultural awareness training.
  • In cases where programs demonstrate success, it is important to provide adequate, sustainable resources for long-term, rather than short-term funding.
  • Adopting a strengths-based perspective which builds and develops the existing strengths, skills and capacities of Indigenous people.
  • Clear plans for research and evaluation to identify successful aspects of programs, provide a basis to amend and improve, demonstrate success and build an evidence base to justify allocation of ongoing resources (Osborne et al. 2013).
Accessibility of health services in urban and regional settings
  • Addressing physical and economic barriers through strategies such as:
    • providing services locally
    • providing transport to health services
    • having flexibility in setting appointments
    • using home visitation as part of a multi-faceted engagement
      strategy
    • increasing services that do not require co-payment
    • improving access to private health insurance and private health
      services.
  • Addressing cultural competence, acceptability and appropriateness through strategies such as:
    • developing services around the holistic model of health and wellbeing
    • building therapeutic and clinical relationships based on trust and mutual respect
    • employing Indigenous health professionals and health workers to promote culturally safe service delivery
    • where feasible, providing a choice between Indigenous-specific and non-Indigenous-specific health professionals and services
    • adopting strategies that support cultural competency and safety at the systemic, organisational and individual levels, including appropriate communication styles, and working through community Elders and kinship networks
    • providing services in non-traditional settings (Ware 2013a).
References

CtGC 2012b. Healthy lifestyle programs for physical activity and nutrition. Resource sheet no. 9. Produced by the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 68. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs09.pdf>

CtGC 2013a. Strategies to minimise the incidence of suicide and suicidal behaviour. Resource sheet no. 18. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 83. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs18.pdf>

CtGC 2013b. Strategies and practices for promoting the social and emotional wellbeing of Aboriginal and Torres Strait Islander people. Resource sheet no. 19. Produced by the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 82. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs19.pdf>

Gray D & Wilkes E 2010. Reducing alcohol and other drug related harm. Resource sheet no. 3. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 35. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctgc-rs03.pdf>

Ivers R 2011. Anti-tobacco programs for Aboriginal and Torres Strait Islander people. Resource sheet no. 4. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 37. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2011/ctgc-rs04.pdf>

Osborne K, Baum F & Brown L 2013. What works? A review of actions addressing the social and economic determinants of Indigenous health. Issues paper no. 7. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 113. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-ip07.pdf>

Strobel NA & Ward J 2012. Education programs for Indigenous Australians about sexually transmitted infections and bloodborne viruses. Resource sheet no. 14. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 72. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs14.pdf>

Ware V-A 2013a. Improving the accessibility of health services in urban and regional settings for Indigenous people. Resource sheet no. 27. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 114. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs27.pdf>

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Economic participation

Economic participation

What works

Indigenous school leavers
  • Enhancing the potential productivity of the Indigenous workforce by facilitating training and education is the policy that is most likely to be effective. Accordingly, it is important to first overcome barriers to Indigenous participation in education and training. The recognition of the diverse and distinct cultural and social life experiences of Indigenous school leavers is crucial.
  • There are good theoretical reasons to expect that Indigenous input is imperative for all activities aimed at increasing Indigenous participation in programs and hence enhancing their effect. This principle holds for schools, university/VET sectors and labour market programs. The evidence on outcomes is consistent with the benefits of Indigenous participation in program design, but the existing evaluations are largely descriptive in nature.
  • Among labour market programs, wage subsidy programs are consistently identified as having the best outcomes for Indigenous jobseekers (Hunter 2010).
Increasing Indigenous employment rates
  • Increasing the skill levels of Indigenous Australians via formal education and training.
  • Pre-employment assessment and customised training for individuals in order to get Indigenous job seekers employment-ready.
  • Non-standard recruitment strategies that give Indigenous people who would be screened out from conventional selection processes the opportunity to win jobs.
  • The provision of cross-cultural training by employers.
  • Multiple and complementary support mechanisms to improve the retention of Indigenous employees is crucial. These may include:
    • on-going mentoring and support
    • flexible work arrangements to allow Indigenous employees to meet their work, family and/or community obligations
    • provision of family support
    • addressing racism in the workplace via initiatives such as the provision of cross-cultural training.
  • Wage subsidy and other labour market programs can be effective for Indigenous job seekers.
  • A strong macro-economy which creates a range of new jobs.
  • Having explicit Indigenous employment goals for government programs which deliver goods or environmental or personal services (Gray et al. 2012).
Employment of ex-offenders
  • Programs incorporating Indigenous knowledge and practices, particularly those involving Indigenous facilitators or traditional elders in delivery.
  • Programs with a long-term focus (minimum one-year) and a strong case-management approach. A comprehensive and personalised case-management approach can have a significant positive impact on employment outcomes for individuals.
  • Transition programs that begin pre-release and continue for several months post-release, with clearly stated program objectives and individualised assistance.
  • Programs that take a broad approach to post-release support by tackling issues relating to social disadvantage as well as employment.
  • Programs that incorporate on-the-job work experience with other forms of support, such as mentoring (Graffam & Shinkfield 2012).
References

Graffam J & Shinkfield A 2012. Strategies to enhance employment of Indigenous ex-offenders after release from correctional institutions. Resource sheet no. 11. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 58. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs11.pdf>

Gray M, Hunter B & Lohoar S 2012. Increasing Indigenous employment rates. Issues paper no. 3. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 35. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctg-ip03.pdf>

Hunter BH 2010. Pathways for Indigenous school leavers to undertake training or gain employment. Resource sheet no. 2. Produced for the Closing the Gap Clearinghouse. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctgc-rs02.pdf>

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Healthy homes

Healthy homes

What works

Design and construction
  • Design and construction of Indigenous housing. There needs to be meaningful consultation with Indigenous communities in each local context, as well as utilisation of established standards and accumulated knowledge.
  • Culturally appropriate design. Indigenous housing needs to be designed to meet the cultural requirements of Indigenous communities and households. This includes allowing space to accommodate kin visitation, and to negotiate avoidance relationships. The requirements may vary between cultural groups, so housing design for one geographic region should not be predicated on the cultural practices of another. Likewise, construction methods and materials that are appropriate to the particular local environment, especially in rural and remote locations, improve the appropriateness and sustainable functioning of housing.
  • Prioritisation of safety and health. Where there are limited maintenance budgets, prioritising safety and health items improves the functional performance of the house.
  • Local capacity building. Using local community Indigenous labour in the planning and implementation of construction and maintenance programs increases workforce capacity, and may contribute to improved labour force participation. It also increases ownership of home improvements.
  • Inspection of housing refurbishment and construction. Conduct rigorous inspection programs at handover to ensure that house construction complies with the drawings and specifications, and is functional at the time of handover.
Homelessness
  • Homelessness prevention and support programs. Early intervention can prevent young families from becoming homeless, and can break the cycle of homelessness. This may involve provision of culturally relevant and safe tenancy support programs for families, or the provision of housing services which incorporate wrap-around supports for residents.
  • Supporting homeless Indigenous people with a mental illness, physical or intellectual disability. Supported accommodation for Indigenous people with a physical or intellectual disability or mental illness requires provision of a range of flexible supports tailored to their individual needs. These can help maintain tenancies otherwise at risk of failing, thereby preventing a return to homelessness. Well-maintained housing is linked with lower mental health-care costs in the general housing literature (CtGC 2012a; Pholeros & Phibbs 2012).
Housing strategies that improving Indigenous health
outcomes
  • Addressing infrastructure, health promotion and the policy environment simultaneously.
  • Effective policy environments that administer and enforce appropriate housing standards and design guidelines, while allowing sufficient flexibility to tailor designs and materials to local conditions.
  • Indigenous environmental health workers are vital for ongoing housing maintenance and the promotion of healthy living practices.
  • High-quality, well-maintained health hardware such as taps, toilets, showers and sinks, coupled with attention to safety of a house, can make a major positive impact on Indigenous health for any age group.
  • Improving indoor temperature regulation, as well as preventing damp, mould and fungi, reduces respiratory and skin diseases.
  • Involving communities in the design, construction and maintenance of housing empowers them and builds capacity for improved housing-related health outcomes (Ware 2013b).
References

CtGC 2012a. What works to overcome Indigenous disadvantage: key learnings and gaps in the evidence 2010-11. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 69. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/
what_works_to_overcome_disadvantage_2010-11.pdf
>

Pholeros P & Phibbs P 2012. Constructing and maintaining houses. Resource sheet no. 13. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. 73. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctgc-rs13.pdf>

Ware V-A 2013b. Housing strategies that improve Indigenous health outcomes. Resource sheet no. 25. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. 110. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs25.pdf>

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Safe communities

Safe communities

What works

Safety and wellbeing of Indigenous children
  • Principles and practices showing 'promise' for preventing and responding to maltreatment of Aboriginal and Torres Strait Islander children include:
    • actions that take into account the historical context and prioritise cultural safety
    • control of services and responsibility for outcomes resting with Indigenous-managed agencies that provide holistic services, and which are appropriately resourced and supported
    • providing support for all families when they need it, as well as targeting services for vulnerable families that address the risk factors for child maltreatment, including parental risk factors such as substance misuse, family violence, mental illness and poor parenting skills
    • empowering families to make decisions to protect children or create safe arrangements for their care
    • community-level strategies based on social inclusion and situational crime prevention principles (Higgins 2010).
Mentoring Indigenous youth at risk

Within the mentoring relationship, what works includes the following:

  • Long-term mentoring relationships of at least 12-18 months duration, based on common interests, mutual respect, genuine friendship, fun and a non-judgemental approach.
  • Mentoring that continues to support the young person as they consolidate positive changes.
  • Consistent, regular contact between mentor and mentee. In the initial stages, this may need to be quite intensive (up to 10-20 hours per week), depending on the young person's needs.
  • Involvement of Indigenous parents in the mentoring relationship, which can improve parent-child relationships.
  • Mentors who have 'been there, done that'. Mentors who have experienced similar challenges to those facing the mentee and proven their success in overcoming negative life circumstances are the most influential in achieving positive behavioural change (Ware 2013c).
Diverting Indigenous offenders from the criminal justice system
  • Positive outcomes found for diversion programs include reduced drug and substance use, and improved social functioning.
  • There is some evidence that diversion programs reduce reoffending, but the evidence is not strong.
  • Diversion programs of between 12 and 18 months have better outcomes than those of very short or extended durations.
  • On-the-job work experience and other forms of support, such as mentoring, help reduce reoffending and promote reintegration into the community.
  • Culturally appropriate treatment initiatives and rehabilitation boost the participation in and completion of a diversionary program.
  • Programs that address the concerns of Indigenous defendants by involving Indigenous Elders or facilitators in delivery work better (CtGC 2013e).
Alcohol and other drugs
  • The National Drug Strategy Aboriginal and Torres Strait Islander Peoples Complementary Action Plan provides a comprehensive framework for the provision of alcohol and other drugs (AOD)-specific interventions—including supply, demand and harm-reduction strategies.
  • There is an extensive national and international evidence base for effective intervention and, although it is limited, the evidence from Indigenous studies is congruent with these broader findings.
  • Effective supply-reduction strategies include price controls, restrictions on trading hours, reducing alcohol outlet density, dry community declarations, substitution of Opal fuel for unleaded petrol, and culturally sensitive enforcement of existing laws.
  • Effective demand reduction strategies include early intervention, provision of alternatives to AOD use, various treatment modalities and ongoing care to reduce relapse rates.
  • Effective harm reduction strategies include provision of community patrols, sobering-up shelters and needle and syringe exchange programs.
  • Factors which facilitate the effective provision of AOD services to Indigenous Australians include Indigenous community control, adequate resourcing and support, and planned, comprehensive intervention (Gray & Wilkes 2010).
Interpersonal safety
  • Restricting the supply of alcohol in a remote Aboriginal community resulted in decreased domestic and public violence and antisocial behaviour. Community members reported that an increased police presence was effective in stopping alcohol being brought into communities and in reducing family violence. Evidence also exists for court diversion programs and workforce development in relation to substance use (Day et al. 2013).
Community patrols
  • Night patrols have the potential to increase community safety, by preventing crime, reducing alcohol-related harm and empowering the local community. The most successful patrols are supported by the community, the police and community services (CtGC 2013c).
Trauma
  • Trauma-informed services directly deal with trauma and its effects. Such services:
    • understand trauma and its impact on individuals (such as children), families and communal groups
    • create environments in which children feel physically and emotionally safe
    • employ culturally competent staff and adopt practices that acknowledge and demonstrate respect for specific cultural backgrounds
    • support victims/survivors of trauma to regain a sense of control over their daily lives and actively involve them in the healing journey
    • share power and governance, including involving community members in the design and evaluation of programs
    • integrate and coordinate care to meet children’s needs holistically
    • support safe relationship building as a means of promoting healing and recovery (Atkinson 2013).
Sports and recreation programs
  • Providing a quality program experience heightens engagement in the sports or recreational activity.
  • Where no activity has been previously made available, offering some type of sport or recreation program to fill that void should be given priority over making selective decisions about which program to carry out.
  • Linking sports and recreation programs with other services and opportunities (for example, health services or counselling; jobs or more relevant educational programs) improves the uptake of these allied services. This assists in developing links to other important programs for improving health and wellbeing outcomes, or behavioural change.
  • For sporting programs, providing long-term sustained, regular contact between experienced sportspeople and participants allows time to consolidate new skills and benefits that flow from involvement in the program.
  • Promoting a program rather than a desired outcome improves the uptake of activities-for example, a physical fitness program is more likely to be well used if promoted as games or sports rather than a get-fit campaign.
  • Involving the community in the planning and implementation of programs promotes cultural appropriateness, engagement and sustainability.
  • Keeping participants' costs to a minimum ensures broad access to programs.
  • Scheduling activities at appropriate times enhances engagement-for example, for young people, after school, weekends and during school holidays, when they are most likely to have large amounts of unsupervised free time.
  • Facilitating successful and positive risk taking provides an alternative to inappropriate risks.
  • Creating a safe place through sports or recreation activities, where trust has been built, allows for community members to work through challenges and potential community and personal change without fear of retribution or being stigmatised.
  • Ensuring stable funding and staffing is crucial to developing sustainable programs (Ware & Meredith 2013).
References

Atkinson J 2013. Trauma-informed services and trauma-specific care for Indigenous Australian children. Resource sheet no. 21. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 95. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctg-rs21.pdf>

CtGC 2013c. The role of community patrols in improving safety in Indigenous communities. Resource sheet no. 20. Produced by the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 99. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctg-rs20.pdf>

CtGC 2013e. Diverting Indigenous offenders from the criminal justice system. Resource sheet no. 24. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 109. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129545614>

Day A, Francisco A & Jones R 2013. Programs to improve interpersonal safety in Indigenous communities: evidence and issues. Issues paper no. 4. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 98. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctg-ip04.pdf>

Gray D & Wilkes E 2010. Reducing alcohol and other drug related harm. Resource sheet no. 3. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 35. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctgc-rs03.pdf>

Higgins DJ 2010. Community development approaches to safety and wellbeing of Indigenous children. Resource sheet no. 1. Produced for the Closing the Gap Clearinghouse. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctgc-rs01.pdf>

Ware V-A 2013c. Mentoring programs for Indigenous youth at risk. Resource sheet no. 22. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 102. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs22.pdf>

Ware V-A & Meredith V 2013. Supporting healthy communities through sports and recreation programs. Resource sheet no. 26. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 111. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs26.pdf>

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Governance and leadership

Governance and leadership

What works

  • Culturally appropriate and culturally ‘safe’ services. These approaches are tailored to suit the local community and communicate acceptance of the local culture, without in any way demeaning the service recipient’s cultural identity.
  • Culturally competent service delivery. Cultural competence is manifested by employing Indigenous workers and culturally aware non-Indigenous staff, emphasising strengths, empowerment, honest engagement, building trust and working with community members.
  • Suitably qualified and experienced field staff. Employing staff who understand the local conditions, have the necessary technical skill, and have established relationships within communities is shown to provide good outcomes.
  • A flexible approach to designing and funding initiatives. This allows for context-specific factors and a range of different ways to address a specific need. Innovative approaches are needed to secure required funding.
  • A community development approach. Specifically, this entails applying a strengths-based approach, a commitment to empower the community, supporting Indigenous staff, and investing the time and resources into ongoing community consultations to ensure relevance of programs and a shared vision. Sufficient lead times are necessary to allow local ownership of programs to be developed. Community trust needs to be built, with program and community leadership demonstrating a commitment to work through and resolve conflict.
  • Leadership development that incorporates core facets of Indigenous leadership styles. In particular, the research suggests that natural leaders should be encouraged to emerge and then be provided with culturally appropriate leadership training. Likewise, the evidence demonstrates that mentoring is a key component of effective leadership development. A modest investment in capacity building of community organisations can yield a significant return (CtGC 2012a; Stewart et al. 2011; Tsey et al. 2012).
Engaging with Indigenous communities
  • Engaging successfully with Indigenous communities requires clarity about the purpose and the relevant scale for engagement, which may call for multi-layered processes: engagement needs to relate to Indigenous concepts of wellbeing.
  • Continuing investments are made to strengthen the governance and capacity development of both Indigenous and government partners for effective partnership. These efforts start early, and continue over the long term, building on existing community organisations and governance structures (Hunt 2013a).
  • Sharing responsibility for shared, realistic objectives and collaborative formulation of criteria and indicators for annual self-assessments, including assessment of the processes as well as the outcomes (Hunt 2013b).
References

CtGC 2012a. What works to overcome Indigenous disadvantage: key learnings and gaps in the evidence 2010-11. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 69. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/
what_works_to_overcome_disadvantage_2010-11.pdf
>

Hunt J 2013a. Engaging with Indigenous Australia - exploring the conditions for effective relationships with Aboriginal and Torres Strait Islander communities. Issues paper no. 5. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 106. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-ip5.pdf>

Hunt J 2013b. Engagement with Indigenous communities in key sectors. Resource sheet no. 23. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 105. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs23.pdf>

Stewart J, Lohoar S & Higgins D 2011. Effective practices for service delivery coordination in Indigenous communities. Resource sheet no. 8. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 61. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2011/ctgc-rs-08.pdf>

Tsey K, McCalman J, Bainbridge R & Brown C 2012. Improving Indigenous community governance through strengthening Indigenous and government organisational capacity. Resource sheet no. 10. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 70. Canberra: Australian Institute of Health and Welfare & Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs10.pdf>

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All building blocks

All building blocks

What works

  • Community involvement and engagement. For example, key success factors in Indigenous community-based alcohol and substance-abuse programs were strong leadership, strong community–member engagement, appropriate infrastructure and use of a paid workforce to ensure long-term sustainability.
  • Adequate resourcing and planned and comprehensive interventions. For example, a systematic approach with appropriate funding arrests the escalating epidemic of end-stage kidney failure, reduces suffering for Indigenous people and saves resources. A strong sense of community ownership and control is a key element in overcoming Indigenous disadvantage.
  • Respect for language and culture. For example, capacity building of Indigenous families and respect for culture and different learning styles were considered to be important for engaging Indigenous families in school readiness programs.
  • Working together through partnerships, networks and shared leadership. For example, an Aboriginal-driven program increased knowledge about nutrition, exercise, obesity and chronic diseases, including diabetes. The educational component, participation of local Indigenous people in the program and committed partnerships with the organisations involved were important to the program’s success.
  • Development of social capital. For example the Communities for Children initiative, under the Australian Government’s former strategy (the Stronger Families and Communities Strategy 2004–2009) highlighted the importance of a collaborative approach to maternal and child health, child-friendly communities, early learning and care, supporting families and parents, and working together in partnership.
  • Recognising underlying social determinants. For example, data from the Longitudinal Study of Australian Children demonstrated that financial disadvantage was one factor among other variables that may affect school readiness and progress for young children.
  • Commitment to doing projects with, not for, Indigenous people. For example, the evaluation of the NSW Count Me In Too Indigenous numeracy program found that contextual learning was successful and critical, professional development for teachers was essential, effective relationships were vital and Aboriginal community buy-in was also essential for ongoing success.
  • Creative collaboration that builds bridges between public agencies and the community and coordination between communities, non-government and government to prevent duplication of effort. For example, a collaborative project between health and education workers at a primary public school in South Australia (The Wadu Wellness project), in which a number of children were screened, has resulted in follow-up and support for children for hearing problems and dental treatment, and social and emotional support.
  • Understanding that issues are complex and contextual. For example, frequent house moves, neighbourhood conflict, functionality of housing amenities and high rental costs were found to have an impact on children’s schooling (CtGC 2011).
  • Flexibility in design and delivery so that local needs and contexts can be taken into account.
  • The importance of building trust and relationships, with an emphasis on retention of staff.
  • A well trained and well- resourced workforce.
  • Continuity and co-ordination of services (CtGC 2013d).

What doesn't work

  • 'One size fits all' approaches. For example, residential treatment for alcohol and other drugs dependency is generally not more effective than non-residential treatment. However, evidence indicates that residential treatment is more effective for clients with more severe deterioration, less social stability and high relapse risk. As these are characteristics of many Indigenous clients, residential treatment may be most appropriate.
  • Lack of collaboration and poor access to services. For example, successful interventions require the integration of health services to provide continuity of care, community involvement and local leadership in health-care delivery and culturally appropriate mainstream services. These steps help to ensure the suitability and availability of services, which can thereby improve access by Indigenous Australians.
  • External authorities imposing change and reporting requirements. For example, a review of evidence from seven rigorously evaluated programs that linked school attendance with welfare payments in the United States found that sanction-only programs have a negligible effect on attendance, but that case management was the most critical variable.
  • Interventions without local Indigenous community control and culturally appropriate adaptation. For example, evidence indicated external imposition of ‘local dry area bans’ (where consumption of alcohol is prohibited within a set distance of licensed premises) was ineffective and only served to move the site of public drinking, often to areas where the risk of harm was greater.
  • Short-term, one-off funding, piecemeal interventions, provision of services in isolation and failure to develop Indigenous capacity to provide services. For example, a one-off health assessment with community feedback and an increase in health service use was unlikely to produce long-term health benefits and improvements. An ongoing focus on community development and sustained population health interventions are needed (CtGC 2011).
  • Lack of cultural safety: Services that do not provide a culturally safe environment are unlikely to engage Indigenous families. Employing local Indigenous staff is one means of providing a culturally safe service. Most importantly, staff need to respect and have an understanding of local Indigenous culture and knowledge. Appropriate images and language in program materials are also important for engaging Indigenous families.
References

CtGC 2011. What works to overcome Indigenous disadvantage: key learnings and gaps in the evidence. Produced for the Closing the Gap Clearinghouse. AIHW Cat. no. IHW 52. Canberra: Australian Institute of Health and Welfare, Melbourne: Australian Institute of Family Studies. <http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2011/
what_works_to_overcome_disadvantage_2009-10.pdf

CtGC 2013d. What works to overcome Indigenous disadvantage: key learnings and gaps in the evidence. Produced for the Closing the Gap Clearinghouse. Canberra: Australian Institute of Health and Welfare, Melbourne: Australian Institute of Family Studies. http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/
15161.pdf

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