Holding Space for the Modern Matriarchy

1.1The Barossa Hills Fleurieu Local Health Network

The BHFLHN is responsible for the delivery of publicly funded hospital and community-based health services across the Barossa Hills and Fleurieu region of South Australia. As a government-designated Local Health Network, BHFLHN plays a key role in developing and implementing health and wellbeing strategies that respond to the needs of diverse populations, including Aboriginal and Torres Strait Islander families. The Network provides a broad range of health services, including acute hospital care, aged care, mental health services, maternal and child health and other community-based initiatives. A Governing Board provides oversight across performance, budget, clinical governance, safety, quality and risk. This Board reports directly to the South Australian Minister for Health and Wellbeing and is responsible for meeting the statutory and operational obligations of the network. BHFLHN has publicly committed to improving cultural safety and health equity for Aboriginal and Torres Strait Islander communities. This commitment is reflected in the Reflect Reconciliation Action Plan 2024–2025, which sets out a strategic agenda for strengthening relationships, respect and opportunities across all areas of health care. The principles outlined in that plan align closely with the values embedded in the Keeping Families Healthy Together model. In recent years, BHFLHN has demonstrated transparency through the publication of annual reports that document service performance and strategic progress from 2019 onwards. Its support for the development of the Keeping Families Healthy Together model includes both strategic leadership and operational backing. This has enabled the use of Indigenous methodologies, community researcher engagement and co-designed approaches that underpin the cultural safety and effectiveness of the model.

1.2Child protection outcomes in the Gawler Region

BHFLHN staff in the Barossa Valley and Gawler region in South Australia have witnessed a transformative and community-led shift in child protection outcomes. Central to this achievement, they believe, is an Aboriginal women-led, culturally grounded model of care that has changed the way DCP notifications are raised. This highlights that the clinician’s role goes beyond raising a notification; it is about open and transparent sharing with parents while holding strength in family. This has led to notifications becoming a relational connection between DCP, SA Health and the families involved, which has enabled them to grow, learn and share together, thereby decreasing the fear of engagement. This outcome, unprecedented in many parts of Australia, demonstrates the strength of an approach that prioritises relationship-based practice, cultural legitimacy and Aboriginal authority, particularly as exercised through matriarchal leadership. The model is built on more than a decade of sustained relationship-building between health practitioners, Aboriginal women, Elders and families. It prioritises cultural authority, matriarchal leadership and relational trust. Health services have shifted from primarily reactive and statutory roles to a proactive approach that supports family wellbeing through early engagement, cultural safety and continuity of care. Practitioners have emphasised that these results reflect not only programmatic changes but also a systemic shift in how services relate to Aboriginal families. Trust has been established through consistent, culturally respectful practice and genuine alignment with community priorities. This has enabled services to intervene earlier and more effectively, reducing the likelihood of statutory involvement. The outcomes in Gawler demonstrate the potential of health services to act as protective and culturally legitimate institutions when guided by Aboriginal leadership and grounded in local relationships, emphasising the importance of embedding culturally governed, relationship-based models within broader service systems.

1.3Redefining the role of health services in child protection work

The Keeping Families Healthy Together model reframes the role of health services within the Child Protection system. Traditionally, health practitioners were positioned as peripheral to statutory DCP processes, with their role largely limited to identifying and reporting risk. Under this model, health services become central participants in preventing child removal and promoting family wellbeing, particularly during pregnancy, birth and early parenting.

Through the implementation of culturally responsive practice and Aboriginal leadership, health services, most notably at Gawler, have become sites of early intervention and trusted engagement. Aboriginal families describe these services as places where they can seek support without fear, supported by culturally safe, consistent care and strong relationships with Aboriginal staff. This means families engage proactively with services rather than avoid them.

Community-based initiatives such as ‘Nunga Lunch’ provide informal opportunities for social and cultural connection and improve access to support. These gatherings reduce isolation and enhance service engagement. Families report that relational continuity with culturally competent practitioners and Aboriginal Health Workers supports trauma recovery, parenting confidence and service navigation.

Although highly effective, the model has not reached all families. Some remain disengaged or at risk of exclusion, highlighting the importance of sustained investment in outreach, relational infrastructure and culturally embedded engagement strategies.

This model presents an integrated, culturally informed and relationship-centred approach to child and family health and wellbeing. It recognises that health services have a vital role beyond clinical care; they are essential partners in supporting Aboriginal children to grow up safe, healthy and strong in their identities, connected to family, community and culture.

By embedding cultural authority, relational trust and continuity of care, the model responds directly to systemic issues that have historically undermined Aboriginal families. It aligns with the National Agreement on Closing the Gap, particularly:

1.4Turning child protection engagement into positive experiences

The model supports intergenerational outcomes. Grandmothers caring for their great-grandchildren are supported through kinship care and family conferencing. Young women facing homelessness, domestic violence, or mental health crises are met with compassion and culturally safe practical support. From care connection points or meeting consumers where they are on their journey to birthing and early parenting, services promote holistic wellbeing grounded in Aboriginal knowledge systems.

1.5What cannot be fully captured in this model

Across BHFLHN, mostly female staff have worked with Aboriginal families in ways that extend beyond conventional service roles. Their decisions to practise differently are often shaped by personal values, cultural knowledge and a long-standing commitment to equity and justice. These staff bring consistency, cultural humility and a capacity to engage meaningfully with complexity, attributes that are not easily standardised and cannot be embedded through policy alone. This report offers a detailed account of the model’s design, including program components, engagement strategies and leadership roles. However, it is not a toolkit that can be directly replicated without attention to local context, relationships and cultural governance. The model depends on the right people, in the right roles, operating within culturally safe and community-led structures. The evidence and insights presented here draw on interviews, program documentation, and the experiences of Aboriginal families and service providers. The model has shifted service responses away from surveillance and statutory threat towards relational accountability and cultural care. These shifts rely on the presence of trust, legitimacy and ongoing collaboration within specific local contexts. Adopting similar approaches elsewhere will require a commitment to building relationships, supporting Aboriginal leadership and working within culturally governed structures. The model’s success depends not only on its principles but also on the capacity and trust that enable those principles to be enacted.

While this report describes the structure, principles and implementation of the Keeping Families Healthy Together model, it is important to acknowledge that not all aspects of the model can be fully documented or transferred. Much of its effectiveness depends on relational work that sits outside formal program descriptions. It is difficult to codify culturally informed practice that is underpinned by trust-building and sustained engagement.

This evaluation employed a culturally grounded, community-led methodology that upheld Aboriginal ways of knowing, being and doing. At its core, the approach was designed to be inclusive, relational and accountable to the Aboriginal families, staff and community members involved in and impacted by the program.

2.1Community researcher training and capacity-building

A key component of this methodology was recruiting and training BHFLHN Aboriginal staff as researchers. These staff participated in a two-day workshop – delivered by Karabena Consulting, a Torres Strait Islander woman-led firm with experience in research, evaluation and training – which included roleplays, yarning techniques, co-design principles and trauma-informed approaches, all of which ensured cultural and psychological safety for researchers and participants. This built local capability while embedding Indigenous methodologies and leadership into the research process.

2.2Co-design as a principle and practice

The methodology was underpinned by co-design as both a principle and a practice. Power and control over the knowledge-generation process were intentionally located within the community. Aboriginal leadership led the decision-making around research questions, interview protocols and reporting. Co-design extended to the development of all research tools and processes, thereby ensuring cultural appropriateness and alignment with community values.

2.3Development of ethical and culturally safe research tools

The team developed Participant Information Sheets, consent forms and semi-structured interview guides that adhered to the principles of Indigenous data sovereignty. All tools were reviewed with community researchers to ensure cultural relevance and sensitivity. Participants were offered community payments in recognition of their time and expertise, in line with ethical best practice.

2.4Mixed methods data collection

The evaluation utilised multiple data collection strategies including in-depth interviews with Aboriginal families who had experienced the program, staff interviews conducted by the external consultant and focus groups with program implementation teams led by community researchers. Observational methods, such as participation in community lunch settings, were also employed to observe relational dynamics, service engagement and cultural safety in practice.

2.5Site visits and immersive practice

Site visits were conducted both win the Barossa Valley and Gawler regions to engage with local contexts, build rapport and observe service delivery environments. These visits provided a nuanced understanding of the local health and social support ecosystems, and how trust-based and culturally responsive approaches were embedded in services.

2.6Participatory knowledge exchange and co-authorship

Following data collection and initial analysis, preliminary findings were presented to staff and the community for review and validation to ensure accurate representation. Staff were then invited to co-author the final evaluation report so that their voices and contributions could be formally acknowledged. Mechanisms were also established for knowledge translation, including future workshops, staff briefings and community dissemination events.

2.7Responsive to contractual and emergent needs

In line with contractual obligations, the methodology allowed for follow-up interviews and additional data collection as needed. The research team remained responsive to the needs of staff and the community, adapting tools and timelines to maintain the integrity of the process and the safety of all involved.

Across the Barossa Valley and beyond, a powerful and often overlooked force has shaped the success of service transformation: the leadership of Aboriginal women. This Section explores the distinct contributions of Aboriginal women in care, governance and service redesign, acknowledging their leadership as a foundational logic for effective mainstream models rather than as an addendum. From matriarchs coordinating multigenerational care to young mothers navigating systems with strategic resolve, Aboriginal women are leading through kinship obligations and responsibilities and culturally informed relational authority. Their leadership is also being held, amplified and protected by a growing cohort of allies, particularly women in health and human services, who are willing to step outside traditional power structures and stand beside Aboriginal leaders. This form of allyship is defined by support, not control, with allies walking alongside Aboriginal women to strengthen and uphold their leadership.

3.1Beyond Aboriginal-led

In contemporary service reform, the term Aboriginal-led is often used as shorthand for both cultural authority and community engagement that promotes self-determination. Yet, within this term, a significant and enduring form of leadership is too often hidden: the specific, grounded and gendered leadership of Aboriginal women. This work, which is deeply relational, strategically wise and culturally legitimate, has long underpinned the wellbeing of Aboriginal families and communities. However, its visibility is cloaked by frameworks that assume a singular Aboriginal voice or leadership type. What is frequently described as ‘Aboriginal-led’ is, in practice, Aboriginal women-led, and thus shaped by matriarchal governance, kinship obligations and intergenerational forms of care and protection.

To leave this distinction unnamed is to erase the specific emotional labour, expertise and leadership of women who have consistently carried communities through experiences of trauma, systemic failures and cultural resurgence. This report challenges the flattening of Aboriginal leadership and reactivates the rightful place of women’s leadership in care systems, co-design and community governance. It repositions Aboriginal women from hidden figures within a generic notion of leadership to central architects of change, operating through a lineage of matriarchy that continues to sustain life, law and legacy. The Keeping Families Healthy Together model emerges from a deep lineage of Aboriginal women’s leadership. For tens of thousands of years, Aboriginal matriarchs have sustained complex social, ecological and spiritual systems across the southern continent. From the red ochres of the northern Flinders to the riverine systems of the Murray, Aboriginal women have held responsibility for teaching, caring, decision-making and protecting Country. These were not acts of service alone but of governance, strategy and innovation. This strength has endured despite centuries of imposed disruption. Since colonisation, Aboriginal women in South Australia have navigated dispossession, protectionist policies and the forced removal of children, often being cast in public narratives as passive victims or ‘carers of last resort’. However, these are the women who have continued to hold communities together through crises, to transmit culture and to build new, informal institutions when state systems have fallen short. The Keeping Families Healthy Together model responds to this history. It repositions Aboriginal women as leaders of place-based, culturally grounded service models. These women operate within a matriarchal paradigm, where care is governance and keeping families together is a political, cultural and practical act of self-determination.

In Gawler, this model grew from the strength of community leadership and the deep cultural knowledge that health services – when grounded in trust, relationships and cultural authority – can keep families strong and together. It offers a powerful, community-led response that focuses on early support, healing, safety and connection across generations. Rather than being borrowed from elsewhere, this approach is rooted in local wisdom and shaped by the strengths and priorities of the region. Aboriginal men and women bring unique and complementary ways of knowing, being and doing. Their cultural knowledge continues to guide strong, resilient families and communities. Supporting the wellbeing of Aboriginal women means building on these strengths and investing in systems that:

• celebrate matrilineal leadership and cultural authority
• back locally designed and co-created models of care
• centre healing through community-led approaches
• support Aboriginal women’s aspirations for self, family and Country Informed by Aboriginal concepts of wellbeing, the Gawler model expands leadership beyond positions of power. It defines leadership as the ability to protect, teach, organise, advocate and heal. It sees women as strategists designing interventions that draw from kinship systems, cultural law and personal lived experience.

3.2Grounding the model: Country, continuity and contemporary matriarchy

Long before colonial intervention, Aboriginal women played central roles in maintaining health and wellbeing through custodianship of Country, ceremonial leadership, and responsibilities for nurturing family and community. These matriarchal systems ensured food security, ecological balance and cultural continuity, and were also systems of governance grounded in reciprocity. Colonisation violently disrupted these systems. Despite more than 65,000 years of cultural continuity, the legal doctrine of Terra Nullius denied Aboriginal sovereignty and erased the legitimacy of Aboriginal lore, culture, and governance structures. The federation of the Australian nation-state in 1901 built on the dispossession of First Nations people, and further entrenched policies of forced removals, exclusion and marginalisation. Subsequent assimilation policies have left enduring legacies, visible today in the disproportionate removal of Aboriginal children from their families, the overrepresentation of Aboriginal people in custodial and child protection systems and the intergenerational burden of poor health. In this context, Aboriginal women have led community responses to systemic harm, reasserting their roles as cultural authorities and protectors of community wellbeing. Their leadership is not new; it is a continuation of roles shaped by Country, storylines and responsibility. The Keeping Families Healthy Together model is a contemporary expression of this matriarchal leadership. It demonstrates how trust, cultural safety and community-led health care can address the structural causes of family separation and facilitate healing.

Health and wellbeing, as defined by Aboriginal people, is holistic. It encompasses spiritual, emotional, social and cultural wellbeing for the whole community, not just the individual. This whole-of-life approach reaffirms that when women are supported to lead from within their cultural systems, entire families and communities benefit. Aboriginal women’s leadership is central to this transformation. It restores the integrity of community life and connects past, present and future through action that is grounded in relational responsibility. This form of modern matriarchy anchors the model’s success in Gawler and provides a blueprint for systems change more broadly.

3.3Reclaiming space: The convergence of matriarchal and reconciliatory leadership

The success of the Keeping Families Healthy Together model is not solely the outcome of Aboriginal women’s leadership in isolation; it is also the result of deliberate and sustained support from women in positions of systemic influence who recognised the need to do things differently. This modern matriarchy has been nourished by a broader ecosystem of allyship: one in which women within bureaucracies, health systems and policy circles have created space for Aboriginal women to lead, shape and enact care on their own terms. Feminist frameworks, when grounded in truth-telling and reconciliation, have made room for the emergence of diverse forms of leadership. These frameworks have helped to question singular models of power and productivity, and instead value relational authority, cultural knowledge and intergenerational wisdom. Feminism, when practised through an ethic of presence and accountability, becomes a mechanism for enabling Aboriginal women to step into governance on their own terms and contribute to the transformation of existing systems. Crucially, this shift has required flexibility within systems; a willingness to make room for non-linear pathways, cultural obligations and care-based leadership that sits outside conventional employment frameworks. These spaces, held open by women committed to cultural and human rights justice, have allowed matriarchal governance to develop, strengthen and take hold.

What we see in Gawler is a coalescence of leadership forms: the deep, enduring strength of Aboriginal matriarchs and the strategic support of women committed to reconciliation and system transformation. This convergence has provided the safety and legitimacy necessary for a new paradigm of child and family wellbeing to emerge, one that is community led, culturally secure and fundamentally gendered in the most powerful sense. Together, these leaders illuminate a path forward, one whereby keeping families together is not only possible, but inevitable, when care is governance and matriarchy is policy.

3.4Co-design as a cultural practice

In the Keeping Families Healthy Together model, co-design is a culturally grounded practice embedded in the everyday functioning of the service, relationships with families and decision-making across teams. In this context, co-design is less about technique and more about cultural practice: a relational, embodied and community-led way of working that reflects the values, governance structures and aspirations of Aboriginal peoples.

Reclaiming the definition of co-design: From consultation to cultural authority Mainstream service systems often treat co-design as a bounded process facilitated through a series of stakeholder engagements or time-limited workshops. In contrast, BHFLHN embeds co-design within the long arc of relational accountability. Here, Aboriginal families are not ‘participants’ in a co-design process; they are active designers of their own care journeys, guided by kinship systems, cultural laws and lived experience.

Practitioner

This reframing shifts the locus of power from service-led models of care to community-held and family-led decision-making. It positions Aboriginal women and Elders as central to the governance of family wellbeing and ensures that service delivery is not imposed, but emerges in response to what families know, want and need.

Relationship first: The architecture of trust The co-design approach within BHFLHN is built on a foundation of long-term relational investment. Practitioners are encouraged to spend time listening, showing up consistently and respecting the rhythms of community life. Rather than extracting feedback or ‘consulting’ with families to justify programs, this model listens deeply, adjusts iteratively, and respects silence and storytelling as design forms in themselves.

Practitioner

Trust is not a by-product, but the infrastructure. It is through relationships that co-design becomes possible, and it is through those same relationships that the model remains accountable.

Enacting sovereignty: ‘We didn’t ask for permission’ Co-design in this setting is also a form of decolonial practice. Rather than waiting for bureaucratic permission or policy alignment, staff acted in accordance with what is right for families, especially when cultural care and safety are at stake. This is enabled by strong internal leadership, an authorising environment that centres Aboriginal governance, and a shared organisational ethic of responsibility rather than deferral. Moving beyond a story of systems improvement, this is a story of systems resistance, where communities reclaim the right to design, adapt and hold services in accordance with their own cultural laws and priorities.

Co-design as ethical relationality The model also recognises that allyship is central to co-design. Aboriginal and non-Indigenous women work together across disciplines to co-create spaces of belonging, healing and learning. Staff are encouraged to engage with cultural humility, admit when they don’t know and learn through doing.

Practitioner

This model of co-design does not rely on a fixed facilitation plan or externally imposed timelines, but instead draws on Aboriginal cultural logics of reciprocity, obligation and collective responsibility. In so doing, it foregrounds values such as:

• Consent and agency: Families decide who is at the table and what is shared.
• Kinship and continuity: Design is informed by intergenerational not organisational roles.
• Respect for silence and story: Yarning is not a precursor to the work – it is the work.
• Reflection as action: Learning is iterative and grounded in cultural humility.

Applied cultural governance: Co-design in action

Reframing the gaze: From fragmentation to wholeness

Across BHFLHN, co-design is evident in the structure and style of service delivery. Examples include:

Too often, Aboriginal women are subject to colonial and institutional gazes that fragment their identities and experiences. Too often, this leads to them being seen as:

• Roundtable care planning that includes extended family and cultural carers, not just biological parents.
• Family-led meetings where DCP and other agencies are invited as participants, not directors.
• Flexible care protocols that allow for care to be provided in homes, on Country and alongside community leaders.
• Continuous staff reflection processes to revisit care plans and adjust them based on family feedback. These practices have been made possible not through formal frameworks but through the cultivation of a culturally safe, flexible and responsive system where the values of Aboriginal governance take precedence over compliance requirements.

Shifting the gaze: Co-designing as a cultural practice Within the Keeping Families Healthy Together model, co-design is a cultural practice that actively reshapes the gaze through which Aboriginal women are seen and understood. Co-design invites a collective reimagining of how Aboriginal women are perceived, moving beyond externally imposed lenses that fragment, diminish, or stereotype. To co-design in this context is to co-create the very gaze through which the work is done. It means rejecting deficit-based, pathologising frames and instead embracing a gaze rooted in cultural authority, relational accountability and deep listening. This practice allows women to be seen through more than the eyes of policymakers or statutory systems, but through the shared lens of community, Eldership, story and place.

• vulnerable – rather than as women experiencing vulnerability due to violence, poverty, racism, or structural neglect
• impoverished – rather than as women navigating economic exclusion while holding families together through cultural and relational wealth
• dysregulated – rather than as women embodying trauma responses from intergenerational harm, including changes that occur at the cellular and epigenetic level during pregnancy. These gazes come from multiple sources: social workers, police, hospital staff, intimate partners, the general public, politicians and even from within community contexts. They define what is ‘visible’ to systems: who gets help, who is believed and who is deemed a risk. In a co-designed, culturally grounded practice, the gaze itself becomes a site of intervention.

Young mother, Gawler region

Co-design here becomes a political and cultural act; a collective agreement to see Aboriginal women in their entirety, not in fragments. It is about turning away from the harsh gaze of judgement and towards one of kinship and care.

Co-designing with, not for, women

Embodied and intergenerational gazes

Rather than asking Aboriginal women to adjust to systems that cannot see them, the Keeping Families Healthy Together model invites those systems to adjust their gaze. In doing so, it elevates Aboriginal women’s knowledge, agency and leadership in shaping the very terms of their engagement. The process draws on long-held cultural practices: decision-making through yarning, collective witnessing and holding space for story and silence.

This co-designed gaze also honours the embodied and intergenerational realities of Aboriginal women’s lives. Women carry trauma and strength through their memory, bodies, pregnancies, and attachment to their children. The gaze, therefore, holds space both for the immediate and the ancestral, for the daily struggle and the long arc of cultural survival.

A parent reflecting on the cultural safety of the clinic

Co-design here is not a consultation, a focus group, or a set of discrete actions; it is a cultural relationship. The gaze is co-created through the spaces women trust: the lunch table, the birth suite, the drop-in clinic, the moment of eye contact during a panic attack. It is designed by who is in the room, who holds power, who is believed and who is prepared to do the deep listening.

Children, too, look to their mothers with their own gaze, seeking safety, regulation and connection. The co-designed model acknowledges the circular nature of this gaze: when women feel safe and seen, their children become calm, confident and connected. This is not incidental; it is an outcome of relational design.

Parent, reflecting on life after leaving an abusive relationship

Co-design as cultural sovereignty Co-design, when grounded in Aboriginal worldviews, is an act of cultural sovereignty. It challenges colonising perspectives and centres Aboriginal women’s right to define themselves, their families and their communities. Within this model, service provision becomes a means of seeing differently, of recognising and validating the labour, leadership and cultural authority that women bring to family and community life. Each act of care reflects a deeper commitment to cultural logics, kinship, story and accountability. Through this lens, the Keeping Families Healthy Together model positions co-design as a mechanism for cultural authority and structural redefinition; a place where a truthful voice can be heard and held.

Measuring success through cultural accountability The model defines success through culturally informed accountability. Instead of relying solely on conventional service metrics, it draws on questions shaped by community priorities and values, including:

• Did the child remain safely connected to culture and kin?
• Did the grandmother’s role and authority receive recognition?
• Was the care team consistent, trustworthy and responsive?
• Were Aboriginal staff empowered to lead? These questions position families and communities as interpreters of impact, embedding evaluation within relational processes shaped by the same cultural logics that guide care.

3.5Concluding comments

In this context, co-design is a cultural practice that shapes how care is given and received. It is grounded in community values, sustained through relational trust, and led by Aboriginal women whose authority is anchored in kinship and culture. The model supports an adaptive, locally authored and culturally grounded approach that builds healing and strength while enabling systems to shift in response to community-defined priorities.

• Were families heard and respected?

The BHFLHN model is built on foundational trust, developed over 15 years, between community members and Aboriginal health system staff. This trust is relational, enduring and embedded in a culturally safe framework. It has emerged through consistent support, cultural integrity and an unbroken presence, all of which have created the conditions for young women to maintain custody, strengthen their confidence as parents, and engage with services in non-judgemental, strengths-based ways. As one young mother reflected:

Support grounded in cultural safety and relational care offered immediate relief while also creating the conditions for long-term resilience. The model’s strength comes from its continuity – of people, place and sustained commitment. Another young mother, reflecting on her relationship with the service over more than a decade, spoke of how these enduring relationships held her family through grief, parenting challenges and systemic barriers:

She described her connection to the Gawler health team in terms of kinship and belonging:

This sense of relational care extended far beyond clinical care. It was also felt through spontaneous check-ins, shared meals and the emotional labour of staff who stayed connected even outside their formal roles. When asked who stood by her during difficult times, her answer was immediate and heartfelt:

This young woman viewed these staff as part of the family structure that surrounded and supported her. Their presence built a bridge between clinical systems and cultural safety, where listening was prioritised and judgement suspended in favour of understanding. In this way, trust within the BHFLHN model is deeply embodied and constantly enacted. It manifests in who turns up, who stays, who listens and who continues to check in long after other systems have disengaged. It is this trust – earned, relational and grounded in cultural integrity – that continues to keep families strong, together and safe.

4.1Relational accountability and continuity of care

Families consistently described the BHFLHN model as wrap-around care led by Aboriginal women with deep roots in both community and service structures. Care was characterised by relational accountability, with staff regarded as kin rather than external professionals. Long-term relationships were central to the model, offering families a depth of trust and familiarity.

This framing reflects a fundamentally different approach to care than that provided by conventional service systems, which families often experienced as impersonal and lacking continuity. Participants repeatedly named staff whom they recognised for their presence, patience and personal commitment. These ‘deadly’ women remained in families’ lives across critical moments, including pregnancy, grief, mental health challenges, housing instability and DCP involvement. Their sustained relationships fostered trust, which in turn created the conditions for safety. Families shared that they could express themselves without fear of judgement or misunderstanding:

The model’s continuity of care, both cultural and relational, meant families would travel long distances to engage with trusted staff, even when more geographically convenient options were available:

Returning to a place where their history was known and where their children were remembered offered more than clinical care: it offered cultural safety, emotional recognition and intergenerational continuity. These long-standing relationships were actively maintained. The clinic was a place where people felt known, respected and safe. As one participant put it:

Importantly, this trust extended across time and through life transitions. Even when families moved or experienced service gaps, the memory and impact of culturally safe care remained, and people returned not out of obligation, but because they knew they would be treated with care and consistency.

This commitment to relational practice over procedural delivery meant that families did not feel alone or judged. Rather, they were welcomed, celebrated and supported in ways that enabled healing and strengthened their capacity as parents, caregivers and kin. In this model, relational continuity is cultural safety, and it is the reason that many families remain together.

4.2Women’s leadership and cultural governance

The BHFLHN model stands as an exemplar of Aboriginal women-led governance. Throughout the consultations, grandmothers, aunties and young mothers were consistently described as the driving force behind family wellbeing, cultural continuity and decision-making. Their leadership was defined by community legitimacy, kinship responsibility and cultural authority: there was no mistaking that these women were central to service design, case planning and care delivery.

Such expressions of kinship responsibility illustrate how Aboriginal women enact leadership through deep intergenerational care. These roles were recognised and actively supported by the service, with cultural governance embedded, not merely invited, into family support frameworks. Services ensured that kinship care arrangements were respected and that grandmother-led homes were resourced and included in decision-making processes from the outset. This model also highlighted the leadership of young mothers, many of whom faced complex and compounded challenges, including stigma, housing instability, financial and food insecurity and health risks. What set this program apart was its strengths-based approach: non-punitive, affirming and emotionally responsive. Young women were treated as capable, loving mothers and decision-makers in their own right.

Women described being celebrated at milestones, such as the birth of a child, receiving consistent emotional support, and being met with compassion rather than surveillance. One young mother, who had initially considered terminating her pregnancy due to overwhelming circumstances, recalled the support she received:

In that moment, her leadership emerged, not only in choosing to parent but in navigating care for her family amid systemic and personal challenges. Her leadership was supported, not suppressed. When asked what helped her feel safe as a parent, she responded:

She also spoke openly about the stigma surrounding mental health, identifying it as a barrier that often pushes Aboriginal parents away from support systems:

These reflections reinforce the BHFLHN model’s emphasis on early, non-judgemental support. They show that strengths-based approaches do not ignore vulnerability; they respond to it with care, respect and cultural understanding. Emotional resilience was recognised as a community resource to be cultivated.

Leadership within this model also extended to collaborative processes. Roundtable planning brought together Aboriginal Health Workers, social workers, midwives and, when necessary, DCP representatives. These gatherings upheld cultural safety and de-escalated adversarial dynamics by centring trust and transparency.

Families described these meetings as spaces of safety and solidarity, where decision-making was shared rather than imposed. In this model, the act of walking with families through risk was the norm. Risk was not a reason for removal; it was a prompt for creativity, prevention and co-designed pathways forward. Through these approaches, Aboriginal women across generations – young mothers, aunties and Elders – were recognised and supported as the cultural and structural backbone of the system. The BHFLHN model affirmed that keeping families together means supporting the women (and men) who hold them. It resourced not only their survival but also their leadership.

4.3Embedded cultural practice and family-centred connection

A defining feature of the BHFLHN model is its seamless integration of culture into all aspects of service delivery. For families, care was not restricted to clinic appointments or formal case management; it extended into daily life through shared meals, yarning circles, school pick-ups, home visits and spontaneous check-ins by familiar Aboriginal staff. Culture formed the foundation of how the service operated, from governance to language to lunch.

These gatherings were cultural infrastructure; they built trust, reduced isolation and strengthened collective identity. Their absence, when staffing or programs changed, was deeply felt.

Such reflections highlight how cultural connection operates as both a protective factor and a healing practice. Informal spaces like the Nunga lunch provided emotional nourishment, community cohesion, and opportunities to share knowledge and experience. They also created space for humour, celebration and grieving – functions often excluded from clinical or bureaucratic models of care. The importance of these cultural touchpoints was mirrored in the role of Aboriginal outreach staff, who acted as consistent, trusted figures across time and space. One participant shared her distress at the absence of Joan, a worker with whom her family had previously maintained close ties:

This disruption of cultural continuity, caused by staff changes, resource gaps, or service restructuring, was experienced as a form of cultural dislocation. These women weren’t just losing a worker; they were losing connection to a known and trusted system of care. This loss was compounded by structural hardship. Housing instability, poor living conditions and inadequate public infrastructure all magnified the stress carried by Aboriginal families. One participant clearly described the daily impacts of this:

Such conditions are core to understanding how environmental injustice, poverty and intergenerational inequality intersect with health and wellbeing. The BHFLHN model did not ignore these issues; instead, it created culturally safe spaces where families could disclose them, be believed and receive support without shame or surveillance.

This ethos of relational honesty extended into the clinic’s response to any involvement by the DCP. When families were at risk of statutory intervention, the team leaned in to help de-escalate fear, hold space for difficult conversations and push back on punitive responses. They also offered truthful, supportive dialogue and advocated fiercely, when necessary, by reminding the external systems of the importance of centring the child’s connection to family, culture and Country as a non-negotiable aspect of wellbeing.

Ultimately, the impact of this culturally embedded model was evidenced in shifts to family dynamics, improved communication and stronger kinship ties:

Families consistently reported that this model of care kept them together, reduced involvement by the DCP in their lives, and strengthened relationships between parents, children and extended kin. These outcomes are not incidental; they are the direct result of a service model that is led by Aboriginal women, grounded in culture, and delivered with integrity, consistency and deep respect.

4.4What services need to know

Families who engaged with the BHFLHN model shared not only their own experiences but also their insights into what distinguishes culturally safe, effective services from those that continue to cause harm. One of the strongest messages to emerge was the need for services to operate from a foundation of relational care that is based on trust and cultural understanding. Participants emphasised the importance of genuine human connection over procedural compliance, calling for culturally informed responses instead of a narrow focus on forms, referrals or risk frameworks. As one mother explained:

She acknowledged that while service providers operate within systems, the relationships they build, especially with young parents, can be transformative. Her plea was simple yet powerful:

This reflection points to a central flaw in many mainstream services: the tendency to respond to distress with surveillance rather than support. In contrast, the BHFLHN model is grounded in compassion and a belief in families’ capacity to thrive. Staff saw each family as whole – shaped by histories, cultural obligations and kinship ties – not as problems to be fixed. As one Elder framed it:

In Gawler, families felt seen in their entirety. Grandmothers, aunties and other kinship carers were treated as essential to a child’s wellbeing. Their knowledge was sought, their caregiving acknowledged, and their leadership included in planning and decision-making.

This stood in sharp contrast to experiences with other services, where kinship care was often ignored or actively devalued.

Participants made clear that for services to be truly effective, they need to honour Aboriginal ways of raising children, where care is shared across generations and healing is collective. As one grandmother said:

This is not only a cultural truth but a practical reality for many Aboriginal families navigating Child Protection systems, poverty and intergenerational trauma. To walk with these families, services need to move beyond deficit-based assessments and focus instead on strengths, stories and relationships. For systems and practitioners looking to offer better support to Aboriginal families, these voices give a clear directive: listen deeply, honour kinship, lead with heart.

4.5Concluding comments

The BHFLHN model demonstrates what is possible when services are designed and delivered under the cultural authority and leadership of Aboriginal women. Across every element of the service – whether clinical care, social support, or governance – women’s leadership has shaped an environment in which trust became the foundation of family engagement.

This model recognises and centres kinship structures, honouring the role of grandmothers, aunties, siblings, and community carers in raising and protecting children. Decisions were made with families, not for them. Emotional and practical support was offered together, grounded in cultural safety and an unwavering belief in each family's capacity for strength and change. What stood out most was the model’s consistency. Families knew they could rely on staff to walk alongside them over time. There was no revolving door, no shifting expectations. Staff continuity and presence built families’ confidence, reduced risk and kept children at home. Community events, shared meals and informal yarning spaces were all central to reducing isolation and reinforcing collective care. Families came together not only in crisis but in moments of celebration, reflection and growth. What unfolded through this approach was not simply a reduction in Child Protection notifications; it was a strengthening of families themselves. Culture was embraced as a protective force, and care was shared across roles and relationships. The result? Children were not removed because communities were resourced and respected in keeping them safe. Children were not viewed through a statutory lens, but recognised as active voices; individuals deserving of dignity, respect and genuine collaboration to ensure their safety and wellbeing. Aboriginal women-led practice in this context is a way of working, relating and governing that transforms how we understand accountability, safety and service. It is grounded in cultural legitimacy, built through trust, and sustained by those who live the responsibility of care every day. This model is not only successful; it is essential. And it offers a powerful insight into what systems can become when they walk behind community leadership, not in front of it.

This Section explains how the Keeping Families Healthy Together model is practically enacted across systems, services and relationships. Rather than introducing a new initiative, it codifies what has already been built by Aboriginal women, their communities and trusted allies over many years of cultural, clinical and relational work. What follows articulates the vision, principles, objectives and core actions that make the model work on the ground. It provides a cultural infrastructure within which the child protection and health systems can align to honour the local, place-based and kinship-governed practices that keep families strong and together.

6.1Vision

To uphold the right of Aboriginal families to remain strong, healthy, connected and together. This vision recognises the enduring leadership of Aboriginal women, whose cultural authority is located in kinship, caregiving, and the responsibilities that come with holding families and communities through hardship and healing. Health services become places of connection and early support, rooted in cultural safety and built on trust. Care begins with dignity, not deficit. This model meets families where they are at, affirms their strength, and restores the relational and cultural systems that have protected children for generations.

6.2Objectives

The objectives of this model, listed here, strengthen Aboriginal family life through care that is early, culturally anchored and family led. Each objective reflects a commitment to structural transformation, not just to service adaptation.

• Prevent child removal through early, voluntary and culturally secure engagement.
• Strengthen family capacity and cultural identity.
• Redefine the role of health services in protective care.
• Create a trust infrastructure within health and community services.
• Embed matriarchal and allied women’s leadership.
• Support trauma-informed and culture-held healing.
• Ensure continuity of care across generations and geographies.
• Elevate Aboriginal women’s leadership in health and social services.
• Co-create safe spaces for meaningful engagement.
• Foster gender equity and structural inclusion.
• Promote economic independence and cultural entrepreneurship.
• Establish an Allyship Community of Practice for learning and legacy. Where child removal is necessary, guarantee a strong voice for families and children in the context of their worlds, supporting them through growth and collaborative efforts.

6.3Principles

The BFHLHN model is held together by principles that centre women’s leadership, cultural governance and relational accountability. These are the ethical and operational foundations that keep the model true to its community roots while making space for institutional change.

6.4Operationalising cultural governance

This model is made real through daily practices that uphold cultural legitimacy and protect the leadership of Aboriginal women. These actions are not step-by-step processes; they are cyclical, relational and grounded in place.

6.5Relational conditions for change

Transformative practice within the Keeping Families Healthy Together model is driven by the cultural and relational conditions that enable trust, innovation and family leadership. Risk is understood as a shared cultural responsibility. It is not imposed through institutional surveillance but redefined through the strength of kinship care and community knowledge. Safety is co-created with families who determine what support is needed and when. Plans reflect lived realities, not bureaucratic assumptions. Innovation arises through deep listening, cultural humility, and the willingness of practitioners to walk alongside rather than direct.

Family-led practice is foundational. Families are not positioned as passive recipients of care but as decision-makers. Their cultural authority shapes the structure and intent of roundtable meetings, where care plans are developed through kinship protocols, community logic and collective knowledge. Practitioners are accountable to these cultural frameworks, not just to organisational policies. Relational casework enables long-term support grounded in trust and continuity. Practitioners stay present across time, life stages and service transitions. This sustained engagement strengthens cultural connection and reduces the risk of fragmented care.

Several enabling conditions make this work possible. Time is critical. Relationships that hold cultural authority cannot be accelerated to meet funding cycles. Trust is built over years, not months. Cultural safety is enacted in the everyday. It is shown through respectful, consistent behaviour, not claimed through certificates or declarations. Allyship requires humility, reliability and a deep commitment to relational practice. Non-Indigenous practitioners and leaders must actively support cultural authority, not override it. Kinship is the governance model. It determines who leads, how care is structured and what accountability looks like. Recognising kinship as both a care system and a leadership structure ensures that services remain culturally grounded and responsive to the realities of Aboriginal family life. Together, these elements form the relational infrastructure that enables meaningful change, where care is not delivered to families but created with them in ways that uphold dignity, trust and cultural sovereignty.

6.6Resource allocation and workforce sustainability

The Keeping Families Healthy Together model is built on deep relationships, cultural governance and sustained presence. These are not incidental features; they are the conditions that make the model work. As the model grows and is considered for implementation beyond the Barossa Hills Fleurieu Local Health Network, it is critical to acknowledge that its success depends on roles that are already operating beyond capacity. The current demands placed on practitioners, particularly those in culturally embedded and relational roles, far exceed existing resourcing. As consumer needs grow more complex – across mental health, housing, intergenerational trauma and family violence – so too does the need for consistent, high-quality clinical and cultural care. Without increased investment, the ability of the model to deliver proactive rather than reactive support is at risk. This is especially true in the Gawler region, where demand continues to outpace capacity and where additional social and emotional wellbeing (SEWB) workers, Aboriginal Maternal Infant Care positions and allied staff are needed to meet the scale of family needs in the context of health and wellbeing.

The BHFLHN team includes unique and critical roles such as the Advanced Clinical Lead – Women, Child and Family Safety, whose expertise spans policy, clinical governance and cultural accountability. These roles are not easily replicable; they require strategic investment, long-term capability-building, and a deep understanding of place-based and culturally specific practice. If other LHNs are to implement this model with integrity, they ought to commit to resourcing these positions appropriately rather than assuming existing structures can absorb the work. Additional funding would strengthen multiple aspects of the model, including:

• more frequent and sustained engagement with families through outreach, accompaniment and cultural programming
• stronger integration with external services, allowing for coordinated care across health, housing, mental health, and child and family services
• greater capacity to implement and evaluate innovative practices, including cultural supervision, narrative-based healing and kinship governance mechanisms
• enhanced workforce development through mentoring, supervision, training and allied leadership roles across the region. Investment in these areas is not only clinically sound, it is financially strategic. Early, culturally safe, community-based support reduces the demand for high-cost, acute interventions and enables families to remain together, safe and connected. Critically, this model ought not (cannot) be lifted and dropped into other contexts without care. Cultural legitimacy, matriarchal leadership and sustained community relationships cannot be replicated without deliberate investment in the roles that hold them. This is not a scalable program; it is a place-based, culturally governed practice that demands equally serious commitments from any service system seeking to adopt it.

6.7Implementation of the model: Cultural conditions, relational actions

The Keeping Families Healthy Together model is not sustained by policy instruments or program logic alone. Its strength lies in the deep and enduring commitments made by those enacting it. The following foundational commitments are not ancillary to the model; they are its operational heart.

• Kinship-centred care: The model draws its structure and relational logic from Aboriginal kinship systems. Grandmothers, aunties and extended kin are recognised not as informal supports but as leaders, cultural authorities and the backbone of family care.
• Cultural leadership: Aboriginal women lead with integrity, relational depth and cultural legitimacy. Their leadership shapes service logic, team dynamics and family engagement. This is not leadership by designation but by relational presence and community trust.

• Cultural fluency in practice: Staff are supported to learn, reflect and act with cultural humility. This is not about completing training but about cultivating ethical sensibility, relational awareness and readiness to be changed.
• Responsive care systems: Services adjust to family-defined needs and rhythms. Practitioners listen, adapt and walk alongside families across life stages, not only in crisis.
• Narrative-based accountability: Evaluation is grounded in lived experience, cultural indicators and the relational effects of care. Families and communities shape how success is defined and how learning occurs. These commitments, which provide the architecture through which transformation occurs, are interwoven practices shaped by Country, culture and community leadership. Sections 7 and 8 build on these foundations to identify critical considerations for those seeking to apply the model elsewhere.

• Relational continuity: Trust is built through consistency. Staff remain present over time, through joy and trauma, creating a foundation of safety that formal systems alone cannot deliver.

Scaling or adapting the Keeping Families Healthy Together model requires more than replication. It calls for a grounded understanding of the cultural, relational and governance commitments that enable it to thrive. These prompts are designed to help systems reflect on their readiness to engage with the model’s principles.

• Cultural legitimacy as a precondition: Adaptation should begin with Aboriginal leadership and kinship-based governance. If this foundation is missing, the conditions for cultural safety will not hold.
• Relational investment as strategy: Systems need to commit to building trust over time. This means long-term staffing, continuity of care, and organisational patience to grow relationships before measuring impact.
• Contextual specificity matters: The model is rooted in Country, community and historical relationships. Implementation elsewhere must be locally led, culturally negotiated and never lifted wholesale.
• Governance must carry authority: Cultural governance structures, such as roundtables and Elder engagement, are not advisory groups. They are decision-making bodies with cultural legitimacy that ought to be operationalised in practice.
• Sustained and targeted resourcing: Implementation will fail without investment in the roles and relationships that sustain the model: namely, an Aboriginal workforce, cultural supervision, peer support, community-led monitoring and kinship carers.

• Allyship as ongoing practice: Non-Indigenous practitioners need to hold space with humility, act with institutional courage, and be willing to share power and to be changed by the process.
• Evaluation shaped by community priorities: Impact ought to be defined by families, not institutions. Indicators like trust, cultural connection and safety must take precedence over compliance and throughput.
• Support systems must be transformed, not supplemented: This is not about adding cultural care to existing frameworks. It is about unsettling dominant logics of risk, authority and control to centre relational and cultural accountability.
• Matriarchal leadership is the architecture: The leadership of Aboriginal women is not a component of the model; it is the model. Systems need to protect and elevate this leadership in structure, not just sentiment.
• Flexibility and cultural responsiveness: Families move across geographies, life stages and support needs. Rigidity will fail them. Implementation must preserve responsiveness, autonomy and care that aligns with lived realities.

This evaluation report offers a rare and deeply grounded account of how modern matriarchy operates in practice among Aboriginal women in the Barossa Hills Fleurieu region of South Australia. It reframes matriarchy not as a mirror image of patriarchal power but as a culturally legitimate system of authority rooted in kinship, care and community-defined responsibility.

9.1Matriarchy as cultural governance

The BHFLHN Keeping Families Healthy Together model reveals that Aboriginal women do not hold power through institutional titles or hierarchical structures. Instead, their authority emerges through cultural legitimacy, continuity of presence and sustained relational accountability. Grandmothers, aunties and young mothers enact leadership by holding families together, making decisions in times of crisis and transmitting knowledge across generations. Their leadership is not an intervention; it is the architecture of daily life. As the report demonstrates, cultural governance is not symbolic. It shows up in roundtable meetings where grandmothers assert kinship rights to care for children, in service planning led by Aboriginal women, and in the quiet, consistent presence of Aboriginal Health Workers who function as relational anchors over decades. This is an example of embedded governance that holds community and culture together.

9.2Relational authority over procedural power

The modern matriarchy evident in this model privileges relational authority over bureaucratic mandate. Women are trusted precisely because they stay, listen, remember and act without judgement. As families attest, what made the difference was not clinical expertise but emotional availability, cultural knowledge and the ability to hold complexity without retreating.

9.3Matriarchy as systemic resistance

This model of care resists the assumptions embedded in dominant child protection and health care frameworks. The Aboriginal women leading this work do not simply soften the blow of harmful systems; they redefine what care and protection mean. Risk is reframed as an opportunity for culturally responsive intervention. Leadership is enacted through walking with, listening deeply and refusing to abandon families in crisis. This form of matriarchy is subversive in the best sense. It does not seek to reproduce state systems in culturally adapted forms. Instead, it insists that cultural forms – such as yarning, shared meals and kinship networks – are the system. When services align with these practices, they become safe. When they do not, they remain sites of harm.

9.4Matriarchy in motion: Care as governance

Crucially, this report positions care itself as a mode of governance. Aboriginal women are more than care providers; they are political actors stewarding community safety, cultural survival and intergenerational stability through their everyday practices. This is matriarchy in motion – responsive, grounded and accountable. It is work practised in the clinic, the home, the car and the park, and through food, language, memory and laughter. It is both intimate and structural. As such, it holds valuable insights for service systems, policymakers and researchers seeking to understand how care, authority and justice can be enacted outside Western institutional norms. This report offers a clear and compelling account of Indigenous matriarchal governance. It is grounded in kinship, expressed through care and sustained by cultural legitimacy. It holds families together through continuity, cultural safety and deep relational trust.

This disrupts the Western bias toward individualised professional practice; instead, it presents a model where collective memory, intergenerational ties and relational continuity are the true indicators of authority. It highlights a distinctly Indigenous logic of power, where who you are in relation to others is more important than your title.