Victorian Aboriginal Early Years Health Framework

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First created November 2023

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Karabena Consulting Trust acknowledges the Traditional Owners of the many lands upon which we conducted workshops and forums to inform the development of the Victorian Aboriginal Early Years Health Framework (VAEYHF). We pay our deepest and sincere respect to Elders past and present. It was a privilege to embark on this journey to prepare the Treaty Generation on Country throughout Victoria.

We also extend those respects to the Aboriginal and Torres Strait Islander people who participated in the workshops and forums. We are moved and inspired by the power of your stories, your willingness to speak your truth, and for your tireless efforts in raising the Treaty Generation.

Finally, Karabena Consulting Trust would like to thank the Department of Health for trusting us with this important work.

Thank you.

Disclaimer

KCT respectfully uses the term ‘Aboriginal’ throughout the report to refer to both Aboriginal and Torres Strait Islander children, parents, families, and people. The use of the term ‘Indigenous’ is used when referencing source documents.

Karabena Consulting Trust is pleased to present the summary reports for the regional Stakeholder Workshops and Parent and Carer Forums conducted throughout October and November 2023. The insights gained from the consultations were powerful and poignant in shaping the VAEYHF. What stands out is the profound dedication of parents and carers in raising the Treaty Generation so they can grow into themselves as self-determined people who are strong in their identity. This is ably reinforced by the unwavering commitment of the early years health professionals who are working tirelessly to engage and support families in their journey.

The timing of the consultations presented challenges in terms of engagement. The Referendum to enshrine a Voice to Parliament was held during the consultation phase. The preceding apprehension in the lead up to the Referendum and the subsequent disappointment upon the outcome (including the observation of a week of silence) understandably impacted the ability for the workforce and families to engage in the workshops and forums. The sense of rejection was particularly palpable in regions where the ‘No’ vote formed a significant majority.

As the consultations phase progressed, the conversations evolved to reflect feedback from previous Workshops and Forums. Thus, Karabena engaged in an iterative process of further testing prior feedback and seeking additional feedback in subsequent sessions. One example is the evolving principles of the Framework, and the corresponding visual used to convey them. This was initially developed after the first week of consultations and revised and tested in subsequent consultations.

Nonetheless, throughout the workshops and forums we consulted with over one hundred participants: workforce representatives, parents, and carers – often both. From these engagements consistent themes emerged that affect early years health services and families across the State. However, there are also distinct issues relevant to specific regions in the State. We present these themes to you in the following report.

Structure of the Report

It should be noted that in-line with the semi-structured format of each workshop and forum, the sections in the report are not all uniform. This reflects the distinct issues and experiences of the workforce and families in each region, and also the number of participants in each session. For instance, we were unable to run activities in the same way with three or fewer participants.

Our primary goal is to prioritise the perspectives and experiences of the participants. The workshops and forums reflect the key issues facing the workforce and families in particular regions, and the conversations were guided by this. Therefore, each section below follows the direction of each workshop and forum.

The order of the report corresponds with the chronological order of the consultations at each location. This, in part, helps provide an insight into to the levels of participation – particularly pre- and post-Referendum, and as the year progressed.

Furthermore, the body of the report contains a synthesis of the main themes from each workshop and forum. Additional materials, such as summaries of butchers’ paper responses, are included at the end of the report in Appendices for reference.

The purpose of this Summary Report, written for the Victorian Department of Health (DH), is to capture the key findings and analysis from the Regional Stakeholder Workshops and Parent/Carer Forums to inform the development of the VAEYHF.

It is evident that there are both universal and regional-specific pressures to be addressed through a dedicated, holistic Framework. These encompass a wide range of issues such as the availability and accessibility of services, housing and cost of living pressures, the challenge of navigating initiatives such as NDIS, funding siloes, workforce shortages, and bureaucratic hurdles to name a few.

More importantly, there are many examples of individuals, community groups, organisations, and models of care providing exceptional support and care to families. These examples need to inform the development of the Framework. We understand that even in these successful scenarios, individuals, groups, and organisations are not immune to the pressures mentioned above, and are often succeeding in spite of these challenges. Therefore, the Framework must further empower the sustainability and growth of such examples.

Karabena Consulting was guided by the following broad themes and questions:

• Preparing the Treaty Generation.
• What are the Aboriginal early years?
• What are the current enablers and barriers in the early years?
• What does the typical journey of a child and family look like in early years services? What should it look like?

From this it was concluded that the Aboriginal early years includes the stages from pre-conception through to starting school, and thus the Framework should reflect these stages.

Furthermore, the following overarching findings emerged:

For this to occur, the Framework should embed the following principles:

Conclusion

The early years professionals and families who participated in the Workshops and Forums provided invaluable insights into the design and principles of the Framework. Whilst the Framework is not yet finalised, the feedback from these consultations has established a clear vision for its development.

Executive Summary

This report aims to capture the views and representations made by the participants at the first Statewide workshop considering the intricacies of healthcare in the early years for the Victorian Aboriginal community. This report embodies the essence of the discussions, feedback, and insights shared during this meeting. Conversations encompassed the challenges faced by health and early education, childcare practitioners working with Victorian families caring for Aboriginal children, painting a vivid picture of their strength, innovative spirit, and persistent battles in achieving culturally responsive health care.

Introduction

Central to the discussions were the gaps in the current systems, with a glaring spotlight on the systemic racism that prevails. The effects of such biases range from subtle microaggressions to deeply entrenched institutionalised racism, both of which hinder access to and degrade the quality of healthcare provision. An overriding consensus emerged: there is an urgent need for an interconnected, adequately funded, and holistic VAEYHF pivoting towards Aboriginal community control, identity, and cultural experiences.

Stakeholder Engagement and Perspectives

The workshop saw a dynamic interplay of ideas and expertise. From individuals working within community-controlled health and early childhood wellbeing/educational spaces, to those in mainstream sectors, the range of perspectives enriched the dialogue and recommendations. Stakeholders were pivotal in identifying the essential elements for an VAEYHF, pinpointing challenges, and suggesting potential targets, all with an underlying goal of creating an effective, culturally secure and identity affirming framework.

Community-Led Solutions and Systemic Fragmentation

Participants were vocal about the fragmentation observed within the Victorian Government's Maternal and Child Health services. This fragmentation, particularly evident in services catering to Aboriginal families during and after pregnancy, was juxtaposed against potential community-led solutions that foster individual and family choices and self-determination. The need to bridge silos and ensure a more cohesive, integrated approach, especially concerning the community-controlled sector, was underscored by the principle of ‘no wrong door’ to effective services.

Vision for the Framework

This report presents a consolidated vision informed by workshop participants. A vision where systemic racism is dismantled, communities have agency and control, and health services resonate with the cultural experiences, aspirations and identities of Aboriginal peoples and their children, the Treaty generation. As we progress, these insights and feedback will be pivotal in shaping the narrative and practices of early years’ health framework in Victoria.

Karabena Consulting, commissioned by the Department of Health, organised a workshop aimed at developing a framework for enhancing health outcomes for Aboriginal families and children during their early years. The key goal was to create a structure that not only addresses the wide-ranging health needs of these communities but also adheres strongly to principles of cultural safety, accessibility, and integrative service delivery. The ensuing discussions illuminated the critical need for a framework that accurately reflects the experiences, needs, and aspirations of Aboriginal families and children in Victoria.

Professionals from various fields, working closely with Aboriginal communities, both in urban and regional settings, brought to the table their diverse experiences. Their roles, which span psychiatric, maternal, and child health nursing, research, education, childcare and policy advisory, have been pivotal in providing culturally safe and effective healthcare.

During the workshop, participants explored varied challenges and successes they have encountered in their respective sectors. Many Aboriginal communities continue to face stark impacts from systemic issues, most noticeably in the realms of youth suicide and healthcare access and delivery. Thus, the workshop aimed to spark meaningful discussions, delve into community experiences, and derive insights into systemic challenges and potential solutions.

The discussion pointed out the prevalent disconnect within the health and social services systems, notably in early childhood care, mental health, and systemic practices. The aim to form a comprehensive VAEYHF crucially ensures the integration and continuity of various health services. The need to look beyond merely a health-centric approach, involving broader social and systemic structures and funding models which currently operate in isolated and often misaligned ways, was also highlighted.

“We've got the Department of Health and one minister who deals with the hospital side of things. Then you've got an entire different department looking after the early years and the Maternal and Child Health nurses and like totally different ministers, different departments. It's been so siloed for so long...”

The workshop, therefore, acted as a forum for discussions related to forming a holistic framework for Aboriginal Early Years Health, concentrating on community control, comprehensive healthcare approaches, and infusing cultural identity and safety within health service provision. In recent times, the Victorian Government and its departments have faced challenges emanating from operating in a fragmented manner, particularly within the maternal and child health sector. The division amongst various ministers and departments, dealing with different aspects of this sector, has obstructed the attainment of a unified health service delivery, impacting a wide demographic, including Aboriginal families and children.

Engagements and Shared Narratives

This section encapsulates the shared narratives that weave the collective and individual experiences of how communities are currently navigating their health and well-being landscapes. The insights are not isolated narratives, but collective echoes of the resilience embedded within families, despite their hardship. Each story unveils layers of insights, challenges, and aspirations that collectively shape the landscape of the VAEYHF.

Emphasis on identity constructs and cultural experiences

Ensuring that Aboriginal identities and cultural experiences are given precedence and seamlessly integrated into the early years healthcare service delivery system is paramount. Focusing on the importance of positioning children’s identity at the core of healthcare provision unveils a pathway to not only enhance social and emotional health and wellbeing outcomes but also fortifying the unique identities and cultural resilience within Victorian Aboriginal communities.

“I want to provide great services for my Aboriginal community, not spend all my time negotiating better outcomes for them in the outside world. We want healthy, happy children and families.”

Aboriginal families often navigate through healthcare landscapes that may not recognise, resonate with or respect their cultural ethos and practices. Through strengthening children’s identity and their capacity to engage with cultural practices, this facilitates parental engagement in cultural experiences from which they may have been previously disconnected.

These practices extend beyond medical care, encompassing trauma informed practices, the facilitation of self determination and of enabling spiritual and cultural healing. Together this work cultivates an environment that inherently respects, acknowledges, and integrates Aboriginal wisdom and methodologies.

“We shouldn't be forcing the Aboriginal parents directly into a mainstream service when there are other options available at the beginning.”

This nuanced perspective of what the Aboriginal Early Years is, calls for healthcare providers, policymakers, and practitioners to immerse themselves in an authentic understanding and appreciation of identity and culture, ensuring that the resultant health frameworks are reflexively aligned with the cultural experiences that the children deserve and that parents can expect and take for granted.

Multidisciplinary Approaches

Some participants championed the pivotal role of an integrative health team within Aboriginal Community Controlled Organisations (ACCOs), spotlighting the critical need to holistically elevate healthcare standards and approaches, particularly within community controlled contexts.

The inclusion of varied professional expertise, such as psychiatrists, paediatrics, allied health, early childcare and education services, maternal and child health nurses, research analysts, and policy advisors, and parental coaches fosters a vibrant and multidimensional health approach that can support parents and carers adeptly navigate through the multifaceted health and wellbeing needs of Aboriginal families through their children’s early years.

These multidisciplinary teams embody the capacity to meticulously comprehend and address the various determinants of health, forging pathways that are not only clinically astute but are also culturally, socially, and communally attuned. Thus, the health outcomes and experiences for Aboriginal children are enriched and amplified through a synergetic collaboration of varied disciplines, uniting their expertise to facilitate access to sustained health strategies that are as profoundly insightful as they are pragmatically impactful.

Addressing Strategy and Impact Disparity

One participant delivered a compelling provocation into the existing strategies’ coherence and efficacy within the health domain. This position offered a critical reflection on their tangible implementation and impact on Aboriginal families. The issues include whether this strategy could positively provide support to families by questioning:

• What is being provided by Aboriginal early years health - is it practical, accessible and impactful where and when parents and carers need support?
• The disparity between what is provided and community impact - does this disparity necessitate a different way of formulating, implementing, and evaluating programs and processes, ensuring that there are powerful, effective and efficient impacts within communities?
• Is funding going to be directed towards models that work, particularly those that focus on culture as a protective factor, are inherently focused on prevention and early intervention? Will the Department allow successful models to scale and for the coordination and integration of services across different fields of practice be realised?
• Is the current service landscape truly child focused and culturally responsive to the children’s identities and needs?

Adopting a Holistic Approach

Participants stated that even though there is an aspiration for a holistic health and wellbeing framework, how the framework is currently being conceptualised and addressed within Aboriginal contexts is not going to meet community needs, nor allow for community services to thrive and flourish. The Aboriginal Early Years need to intersect with more than a health lens, weaving through cultural, socio-economic, and communal narratives to sculpt approaches that are intrinsically aligned with the multifaceted realities experienced by Victorian Aboriginal communities.

“What I'd like to see in the framework is practical ways of actually putting it in place. There's lots of things that are great, great documents, but how do people actually put it in place and who's going to put it in place?”

By embedding a holistic approach, health frameworks would not only address clinical or physical aspects but would intertwine emotional, social, spiritual, and cultural elements, ensuring that individuals and communities are viewed and respected in their entirety. Therefore, the resultant health strategies and interventions would be inherently bound to Victorian cultural and communal contexts, ensuring they are relevant, respectful, and responsive. The Framework would thereby foster an environment where Aboriginal children can participate in their own nations, and the Australian nation and their identities are a source of pride.

Core Issues Identified

This section seeks to examine issues identified through a lens that acknowledges and respects the diversity and complexity of Aboriginal children’s and family’s experiences and narratives. Grounded in cultural respect, community leadership, holistic health and wellbeing, access and equity, these issues extend beyond mere logistical and systemic challenges, penetrating into the social, cultural, and emotional spheres of Aboriginal family life.

These issues not only uncover the prevailing barriers and challenges but also seeks to understand them within the intricate interplay of historical, socio-economic, and cultural contexts that define, inform, and shape health care for Aboriginal children and their families and carers during the early years.

Cultural Respect and Safety

The foundational imperative of recognising and ensuring the cultural respect and safety in healthcare services for Aboriginal families cannot be overstated. Acknowledging the deep-seated history, values, and practices of Victorian Aboriginal cultures need to be evident in all elements of healthcare delivery. For that reason and as Aboriginal families navigate through early years healthcare experiences, it is imperative that:

• Environments and services are not solely focused on clinical provision but become sanctuaries that inherently respect, validate, and safeguard children’s cultural identity.
• Environments and interactions that radiate respect and foster a safe space where Aboriginal families can navigate their health journeys without the burden of cultural alienation, misrecognition or the experience of racism.
• Moreover, such spaces fortify psychological and emotional well-being, which, in turn, positively impact overall health outcomes.

The emphasis on cultural respect and safety needs to be embedded into strategies, policies, and everyday practices, ensuring that every interaction and every strategic decision is meticulously lensed through respect and safety. Only then will we craft a healthcare landscape that is intrinsically aligned with the cultural experiences of families and the identities of children.

Community Involvement and Leadership: Capacity

Community involvement and leadership are critical in sculpting health frameworks that are not only culturally congruent but also empower Aboriginal children during the early years. Community leadership, particularly within health realms, facilitates the curation of health initiatives that are inherently rooted in the cultural, social, and contextual realities of Aboriginal communities. Developing leadership capacities within Aboriginal Early Years ensures that health programs and policies are not merely imposed but are co-created, reflecting the aspirations, wisdom, and pragmatism inherent within these communities. Moreover, community-led initiatives often are relevant, meaningful, and sustainably impactful within communities, crafting a healthcare trajectory that is both empowering and transformative.

Holistic Health and Well-being: Self Determination

A holistic conception of health and well-being is fundamental in ensuring that health frameworks for Aboriginal communities are inherently attuned to their cultural, emotional, social, and spiritual narratives. Holistic health considers not merely the physical or clinical facets but views individuals and communities in their entirety, respecting and integrating their diverse health determinants into healthcare provision. Holistic approaches ensure that interventions and strategies are tailored to the nuanced needs of children and families, developing a healthcare landscape where families can navigate their health and well-being with dignity and integrity.

Access and Equity: A need for family navigators

Navigating through the nuanced landscapes of access and equity unveils layers of challenges and opportunities in creating accessibility and equity. Accessibility, in this context, extends beyond physical access to services; it encapsulates cultural accessibility based on identities, values, and practices of families using services. Ensuring equity necessitates a recognition and commitment to addressing systemic and structural disparities within healthcare contexts. Addressing inequalities and ensuring equal opportunities for health and development involves a comprehensive re-evaluation and recalibration of healthcare strategies and policies.

Challenges and Opportunities

“..but if there's some way that there could be some branching across the Victorian Government departments that deal with pregnancy and beyond that would be an amazing outcome..”

The insights emanating from workshop interactions yield an intricate mosaic, intertwining challenges and opportunities within the domain of Aboriginal children’s health and early years' experiences.

Addressing the equity gap: Regional/urban

Navigating accessibility, especially concerning regional and rural Victorian settings, unveils an undeniable equity gap in healthcare provision for Aboriginal children during their early years. Socio-cultural disparities impoverish the system's capabilities to introduce innovative solutions, which may encompass telehealth and mobile health units or a relaxed form of MCH offered in playgroup settings. The Framework needs to be relevant to and endorsed by regional and urban communities to address the extensive geographical and workforce divides. This includes pay parity for all workers and between the early education and healthcare services across all regions.

Continuity and Consolidation of Care

The essence of continuity and consolidation in the healthcare journey of Aboriginal children necessitates an attentive, life-course approach that intertwines with the rich cultural, social, and spiritual dimensions of health and wellbeing. Herein, the opportunity lies in architecting care pathways in co-design with Aboriginal communities, ensuring smooth, culturally infused transitions that holistically nurture children through their healthcare journeys from birth onwards.

Navigating Policy and Practice

The juxtaposition between policy objectives and tangible practice for Aboriginal children’s health services reveals a complex, often discordant, interplay. Policies need to be not just directives from above but evolved entities that are intrinsically connected to the communities they aim to serve. The underlying opportunity rests in reshaping policy creation and application, ensuring they are deeply rooted in, and perpetually nurtured by, the experiences, voices, and wisdom of Aboriginal communities and healthcare providers.

Manifestation of Systemic Racism

Addressing the pervasive challenge of systemic racism, which subtly and overtly infiltrates varied aspects of service provision and societal structures, demands a robust, sustained, and reflective approach. Systemic racism, manifested through seemingly minute administrative hurdles to broader issues of service access and quality, requires a focused, continuous effort to dismantle and rebuild structures that are inherently supportive and equitable for Aboriginal peoples. The pathway forward necessitates decolonising initiatives and policies, ensuring they are fundamentally anchored in Aboriginal knowledge, practices, and leadership, thereby constructing platforms that are equitable, honourable, and nurturing.

Compelling Inclusions for the VAEYHF

Anchoring our analysis and proposed structures are the threads of cultural safety, accessibility, and a seamless melding of diverse practices and knowledge systems.

Culturally Safe and Accessible Services

Reflections on the importance of establishing early years' hubs within each Aboriginal health service spotlights a nuanced, but fundamental necessity. The hubs are not mere physical spaces but ought to be sanctuaries where cultural safety is palpable, and services are not just available but also accessible and welcoming. These hubs should become the cornerstone, where families and children find not just healthcare, but a warm, culturally rich, and nurturing environment that seamlessly interweaves practical functionality with a culturally invigorating ambiance.

Interconnectedness of Services

Here, the focus should intertwine a clinical and culturally sensitive lens, ensuring that the services, while interconnected, do not lose their cultural authenticity and relevance. It is paramount that the interconnected web of services retains a thorough, embedded understanding and respect for the intricate socio-cultural tapestries that enfold the lives and experiences of Aboriginal children and their families.

Integrating Diverse Practices

The integration of practices from Western and Aboriginal cultures to conceive a healthcare model that is genuinely holistic. Respectful and informed integration necessitates an authentic and deep-rooted understanding of both knowledge systems. The resultant framework should not merely be an aggregation but a synergetic melding where both systems enhance each other, converging towards a model that embraces and nurtures the physical, emotional, and cultural well-being of Aboriginal children from their earliest moments.

Sustaining Care Models

The sustainability of culturally safe early years and maternal health models extends far beyond conventional ‘care’ timeframes. The postpartum journey should be scaffolded by care models that not only uphold but also actively cultivate cultural safety, ensuring that the echo of cultural wisdom and safety permeates throughout the care continuum. The emphasis on scaling and sustaining these models accentuates a need for systemic and community-driven support, privileging a perpetuation of care that is woven with the threads of cultural respect, understanding, and safety.

Early Intervention and Education

The centrality of early intervention and education cannot be overstated. These elements stand as pivotal fulcrums, potentially alleviating health disparities and embedding trajectories of wholesome growth and development for Aboriginal children. Intervention and education must be grounded in cultural knowledge and practices, ensuring that they do not merely ‘intervene’ but holistically nurture and empower children and families within their cultural realms.

Integration of Strategies

Coherence in strategies and policies is not simply administrative efficiency. It is about constructing a scaffold that supports unified, consistent, and culturally embedded practices and policies. This harmonised integration should be shaped and informed by the lived experiences and wisdom of Aboriginal communities, thus forming policies and practices that are not merely applied to, but rather grown with and from the communities themselves.

Supporting Aboriginal-led Initiatives

Support for Aboriginal-led initiatives is integral to a framework that is genuinely respectful and supportive of Aboriginal children and families. This isn’t mere collaboration but an active, respectful, and continual learning and supporting process. The framework should not dictate but listen, learn, and be guided by the wisdom, experiences, and needs of Aboriginal communities, ensuring that their knowledge, practices, and aspirations are not just included but privileged.

This framework aims to embody a respectful, collaborative, and culturally rich and safe approach, intertwining practical, clinical, and cultural dimensions, thereby crafting pathways that holistically and respectfully support the well-being and development of Aboriginal children throughout their early years.

Proposed Platforms in a VAEYHF

Recommendations

These recommendations are grouped under pillars that serve as overarching themes under which the recommendations can be strategically grouped and addressed, facilitating a focused, yet holistic, approach towards enhancing the VAEYHF. Each pillar has been derived from the workshop proceedings and represents a crucial aspect of the holistic approach, ensuring that initiatives are culturally respectful, community-driven, strength-based, technologically advanced, systematically coordinated, and genuinely supportive. Each of these pillars are underpinned by robust metrics, advocacy, and a strategic addressing of socio-economic, cultural and environmental determinants to promote the attainment of early years health and wellbeing.

Recommendations: Pillars in a VAEYHF

Note: after subsequent consultations, Karabena decided not to use ‘pillars’. Instead, the terms ‘elements’ and ‘principles’ are used. This section is retained to demonstrate the evolution of the Framework through the consultation process.

1. Cultural respect and embedded practices

• Aboriginal-Led, Culturally Embedded Health Services
• Embedding and Respecting Cultural Practices
• Framework of Cultural Respect and Safety
• Crafting Culturally-Resonant Programs

2. Strengthening community collaboration and leadership

• Community-Driven Collaborative Initiatives
• Prioritisation and Support for Aboriginal-led Initiatives
• Cultivate and Elevate Community Strengths
• Robust Collaboration and Community Solidarity

3. Empowerment through strength-based approaches and education

• Strength-Based and Empowering Developmental Approaches
• Empowering Education and Skill Augmentation
• Review and Redesign of Health Service Systems

4. Technological and innovative solutions for accessibility

• Technological Solutions and Accessibility Enhancement
• Respectful Research, Innovation, and Technological Bridging

5. Systemic coordination and integrated service delivery

“We've talked about bringing all the sectors together. Well, we've been talking about that for 20 years since I was in juvenile justice 20 years ago...”

• Holistic Health Service Coordination
• Streamlined, Impactful Strategies and Policies

6. Inclusive and respectful metrics and evaluation

• Decolonised, Relevant Health Metrics
• Continuous Learning and Accountability Integration

7. Advocacy, policy, and supportive regulatory frameworks

• Policy Navigation and Advocacy for Supportive Frameworks
• Platforms for Ongoing Community Dialogue
• Targeted Funding and Support for Aboriginal Initiatives

8. Addressing determinants of health and economic stability

• Addressing Determinants of Socio-Economic and Environmental Health
• Addressing the cultural determinants of health and wellbeing

Conclusion

This report reflects the discussions and aspirations of participants at the Statewide workshop. Karabena Consulting is at the beginning of our journey towards creating the Aboriginal Victorian Early Years Health Framework. We are inspired by the heartfelt stories and valuable insights shared during our workshops. It's a starting point, intended to spark sustained and culturally respectful changes in healthcare during the early years. The pathways we've identified, rooted in the resilience and dedication of Aboriginal leaders and healthcare professionals, open opportunities for genuine, systemic change, extending beyond these pages into ongoing actions and dialogues that truly resonate with the aspirations of Aboriginal children, their families and carers across Victoria.

Executive Summary

This summary encapsulates the findings and insights from an online consultation hosted by Karabena Consulting on the Department of Health, with the objective of informing and shaping the Victoria Aboriginal Early Years Framework. The consultation convened a wide array of participants, prioritising inclusion and focusing notably on the Aboriginal community, to explore in-depth experiences and specific issues related to Aboriginal early childhood years in Victoria, Australia.

The dialogues and reflections embedded in this report provide a detailed exploration into the real-world challenges and potential avenues for enhancing early child health and development within Aboriginal communities. A special emphasis was laid on understanding and addressing the distinct and varied needs, especially of Aboriginal women, throughout pregnancy and early childhood development, within the context of the Universal Service Delivery System in Victoria. This multi-stakeholder input is pivotal in developing a framework that is both robust and sensitive to the unique health, cultural, and developmental needs of Aboriginal children during their critical early years.

Introduction

Karabena Consulting, in alignment with its ongoing initiative to enhance health outcomes within Aboriginal communities, hosted an insightful online consultation to directly inform the development of the VAEYHF. This digital assembly coalesced a vibrant mix of stakeholders, practitioners, and community members, uniting their voices and experiences to address key themes and articulate the needs specific to the Aboriginal early years. The subsequent content meticulously synthesises dialogue and feedback traversing imperative facets such as cultural safety, systemic challenges, service delivery mechanics, and the essentiality of a unified approach for the well-being of Aboriginal children and families.

Participants shared a wealth of experiences and knowledge, navigating through crucial areas encompassing maternal and child health, antenatal care, and related services within the geographical and cultural context of Victoria. Deep-rooted discussions unearthed both strengths and vulnerabilities inherent within the Aboriginal communities, particularly spotlighting early years’ development. The explicit need for an all-encompassing approach, which intricately weaves cultural practices and services with parenting practices into the Victoria Aboriginal Early Years Program, emanated prominently from the consultations. This report aims to provide a comprehensive summary of these dialogues, weaving together the collective insights and reflections that will pave the way for sculpting a foundational framework for the Early Years Programme.

Insights from the Consultation

Cultural Strengths and Identity

Fostering Cultural Strength. The consultations unfolded a rich tapestry of reflections surrounding the pivotal shift from a focus on vulnerability to one of cultural strengths and identity in the Aboriginal early years program. Participants posited how the program might usher the development of an environment that is not only culturally strong, safe, and secure but also serves as a protective sheath across diverse service delivery platforms. The dialogue encouraged envisioning a system where cultural strength is central, acting as a buffering agent against societal and systemic pressures, while also facilitating an enriching environment where children can immerse in their cultural heritage with confidence.

Cultural Disconnection. A prevalent theme that emerged was the tangible cultural disconnection experienced by numerous Aboriginal individuals, impacting their capacity to transfer cultural practices and wisdom to their progeny. This disconnection punctuates a breach in cultural continuity and robustness, instigating a cascading effect where children might navigate their growth without a solid anchoring in their rich cultural backdrop. The dissonance echoes the necessity to formulate strategies that bridge this chasm, ensuring that cultural knowledge transmission is seamless and uninhibited.

Health Services and Challenges

Universal Hearing Screening. The consultations unveiled a significant concern regarding the universality and effectiveness of hearing screenings. A staggering insight shared was that every child within the juvenile justice system, who is detained, grapples with undiagnosed hearing issues traceable to their early years. The discourse interrogated the junctures at which these issues could be perceptibly identified and addressed, spotlighting a critical gap in the early identification of, and intervention in, hearing issues.

Health and Audiology Services. Despite the structured audiological and health check-ups available in Victoria, participants pointed to apparent gaps or delays in addressing arising concerns and in forwarding children to specialists. This spotlighted a potential sphere within the system that may be calibrated for enhanced efficiency and responsiveness, ensuring that every health concern is addressed promptly and effectively.

Mental Health Screening

Screening Occurrence. While mental health screenings are systematically conducted both antenatally and postnatally, the discussions unveiled a need to delve deeper and explore alternative, possibly more community-integrated, strategies for executing these screenings. An imperative was voiced to embed mental health discussions and screenings within community dialogues and platforms, ensuring comprehensive coverage.

Additional Screening Agents. The necessity to expand the roster of screening agents was underlined, particularly exploring entities beyond universal service providers. This is aimed at constructing a safety net that ensures screenings are universally conducted, especially for those who may not readily present to universal services, crafting a health service system that leaves no individual behind.

Consultation Findings

Cultural Safety and Contextual Service Delivery. The consultation pinpointed cultural safety as a paramount theme. The requisite for services to be both attuned and perpetually applied was emphasised, especially within mainstream contexts, to ensure an encompassing safe environment, particularly in areas where access to community-controlled organisations is circumscribed.

Counteracting the Deficit Perspective. There was a unified call to diminish the impact of the deficit lens and dismantle systems potentially entrenching racism or perpetuating negative stereotypes. The narrative needs a reorientation towards a strengths-focused approach, assuring service delivery systems resonate with the needs and experiences of Aboriginal peoples.

Synchronising Resources and Services. A stark deficiency in coordination amongst agencies was highlighted, emphasising that optimised coordination is paramount to delivering support, especially to those confronting vulnerabilities like homelessness or addiction issues.

Continuity of Care. There was a significant emphasis on persistent and seamless care across diverse domains such as maternal child health and antenatal care, spotlighting existing programs which embody continuous care and trust.

Flexible Service Delivery. Flexibility was identified as a cornerstone in service delivery, with alternative models often being not just welcomed but actively utilised.

Enhanced Inter-Agency Communication. The necessity for improved communication and unimpeded information sharing amongst services was raised, facilitating cohesive strategies to address community challenges.

Comprehending Client Experiences and Journey Mapping. A considerable dialogue was centred around understanding current client experiences and mobilising additional support throughout the child’s journey through various services.

Envisioning the Aboriginal Early Years. Discussions around defining what constitutes the Aboriginal early years were robust, spotlighting aspects like strengthening the identity of Aboriginal children and activating a kin-centric workforce.

Challenges and Areas for Consideration

Diverse Experiences and Needs. Although the diversity and varied needs within Aboriginal communities are acknowledged, it was noted that the practical manifestation of flexible and adaptable services that address this diversity is often limited. Participants urged for the development and implementation of services that are malleable and can be modulated to meet the diverse, and sometimes unique, needs of every community member.

The Disconnect and Varied Service Delivery. The fragmentations and variations in service delivery, both within a council area and between different areas, were identified as substantial hurdles. To build a more uniform, cohesive, and universally advantageous program, it is vital to meticulously address these disconnects and create a continuum of services that is consistent, accessible, and equitably distributed.

Funding and Coordination Challenges. The discussions acknowledged the limitations of funding and emphasised a pivotal need for adept service coordination. Mechanisms for Visibility and Tracking: creating mechanisms within the system that ensure sustained support throughout the children's transition through different stages and services is critical.

Aboriginality and System Scrutiny. Discussions acknowledged the multifaceted complexity of Aboriginal women potentially being scrutinised or stereotyped within service delivery systems, especially in mainstream ones.

Recommendations

Aligning and Integrating Services. A focus on enhancing alignment and integration of services from antenatal periods through to primary and secondary education phases, ensuring universally accessible health checks.

Implementing Culturally Safe Approaches. Ensuring services are delivered in a culturally safe and accessible manner, directly addressing the nuanced needs and historical contexts of Aboriginal families.

Promoting Education and Accessibility. Increasing awareness and education regarding available services and support mechanisms from preconception through the initial phases of early childhood development.

Mapping the Client Journey. Undertaking a detailed exploration of client journeys, particularly in areas with elevated unborn child protection notifications, to fathom the health and wellbeing statuses of families and initiate supportive interventions.

Developing the Framework: Strategic Considerations

Recognition and Enhancement of Cultural Strength

Uplifting Cultural Strength. The dialogue was interwoven with a recognition that cultural strengths and identity are cornerstones in fostering a nurturing environment for children. The emphasis was placed on not only recognising but magnifying cultural strengths to create a protective, enriching and secure milieu, where Aboriginal children can be deeply rooted in their heritage while navigating their developmental years.

Bridging Cultural Gaps. The noted cultural disconnection and the resultant cascading impact on the transmission of cultural knowledge and practices set forth a dialogue on strategies to bridge these gaps, ensuring a continual thread of cultural wisdom through generations.

Navigating Through Health Service Challenges

Spotlight on Universal Hearing Screening. Alarm was sounded on the palpable gap in early identification of hearing issues, especially given the stark revelation regarding children in juvenile justice. This underscored the need to recalibrate hearing screenings and interventions, ensuring they are both timely and effective.

Efficient and Responsive Health and Audiology Services. Ensuring health and audiology services are not just structured, but also astutely responsive and devoid of delays or gaps, was underscored as pivotal in safeguarding children’s health and developmental trajectories.

A Closer Look at Mental Health Screenings

Holistic Screening Strategies. An emergent theme was to explore and embed more community-integrated strategies for mental health screenings, ensuring that mental health is holistically woven into the healthcare tapestry from both antenatal and postnatal phases.

Broadening Screening Agency Horizons. The inclusivity of screening, ensuring no individual is left in the periphery, brought to light the necessity to explore and engage additional screening agents beyond universal service providers.

Challenges Met with Opportunities

Tailoring Services to Diverse Needs. An echoing theme was to ensure services are not just acknowledging but pragmatically addressing the diversity and varied needs within Aboriginal communities through flexible and adaptable service models.

Ensuring Cohesive and Consistent Service Delivery. The identified disconnects and variances in service delivery unfolded a narrative that there is an imperative to build a program that is uniformly consistent, accessible, and beneficial across council areas, ensuring a cohesive service delivery matrix.

Recommendations

The rich insights from the workshop do not just outline the current environment of early years health but also threads through potential strategic pathways that can guide the direction of the VAEYHF. Herein, the recommendations emerge from the aforementioned outcomes, aligned towards constructing a Framework that is not only robust and inclusive but also deeply rooted in cultural strength, systematic efficiency, and responsive service delivery.

• Rooting Services in Cultural Strength: Develop strategies and programs that not just recognise but amplify cultural strengths, ensuring services are culturally safe, secure and act as a protective layer for children and their families.
• Enhancing Health Service Efficiency: Ensure health services, including hearing and audiology screenings and interventions, are timely, responsive and effective in both identification and intervention of health concerns from early years onwards.
• Holistic and Inclusive Mental Health Strategies: Develop and embed community-integrated mental health strategies that ensure screenings and mental health support are woven into the community fabric, ensuring no individual is left behind.
• Addressing Diversity Practically: Ensure the developed services and programs are not just flexible and adaptable in theory but are practically modulated to meet the diverse and sometimes unique needs of every community member.
• Building Cohesive and Universally Beneficial Programs: Formulate and implement strategies that address the identified disconnects and variances in service delivery, building a cohesive, consistent and universally accessible and beneficial program.
• Develop Culturally Secure Services: It's imperative to craft services and interventions that are deeply entwined with Aboriginal cultures and traditions. These services should mirror and be responsive to the unique needs and aspirations of Aboriginal families, ensuring they feel seen and represented.
• Enhance Accessibility: Focus on heightening the accessibility of services, taking into account variables like geographical locations, the cultural competency of service providers, and linguistic considerations. This ensures a level playing field for all Aboriginal communities, irrespective of where they are based or the dialects they speak.
• Strengthen Community Involvement: Champion a community-led approach. It's essential that Aboriginal communities are not just beneficiaries but active contributors in the decision-making, conceptualisation, and actualisation of the Early Years Programme.
• Establish Continuous Dialogue: It's vital to embed a mechanism for sustained dialogue and feedback loops between those designing the programme, those bringing it to life, and the Aboriginal communities they seek to serve. This ensures the programme is ever-evolving, in tune with the real-time needs and aspirations of the community.
• Strengthened Cultural Embedment: Cultural practices and needs should be thoroughly embedded and prioritised within service delivery, providing not only a culturally safe environment but actively fostering cultural strength.
• Addressing the Service Gaps: An in-depth review and realignment of service provision, particularly in health screening and intervention for issues such as hearing, need to be addressed to ensure timely intervention and support.
• Enhanced Mental Health Support: Reviewing and enhancing mental health support mechanisms and providers, ensuring they are culturally safe, accessible, and effectively integrated into broader service provision.
• Unified Service Delivery: A thorough review to ensure that service delivery is consistent and cohesive across different regions and councils, reducing variability and ensuring all individuals have access to the support they need.

The unfolding of these recommendations will be steered by further discussions, meticulous planning and continual engagement with communities, ensuring the formulated VAEYHF is both reflective of and responsive to the real, lived experiences and needs of the Aboriginal communities in Victoria.

Further Considerations

In devising a robust and effective VAEYHF, a meticulous analysis of the pressing issues derived from community consultations is paramount. It must be underscored that these issues and subsequent strategies are interwoven in a rich cultural and community fabric, necessitating approaches that are both sensitive and resonant with Aboriginal perspectives.

One of the salient issues revolves around engagement with the community. The dialogues from various regional consultations, including those from the Shepparton region, elucidated the complexities encompassing recruitment, infrastructure development, and synergistic service delivery, particularly with mainstream services. To weave a framework that is resonant with the community’s needs and aspirations, it is imperative that the unique challenges and triumphs experienced in different regional contexts are meticulously considered and integrated into policy and strategy development.

A recurrent theme from the consultation was the challenges within the workforce, particularly related to recruitment, infrastructure development, and the formation of cohesive service units in various regions. Crafting solutions for workforce challenges necessitates a multidimensional approach that addresses the disparities and challenges in recruitment, especially in positions that serve young Aboriginal families effectively, whilst also considering the varied geographical and socio-economic contexts of different regions.

Service accessibility and the provision of culturally safe spaces have emerged as pivotal concerns. A delicate equilibrium needs to be struck between offering services that are deeply embedded in cultural safety while also being readily accessible and welcoming to the community members. This involves not merely physical accessibility but also a cultural and emotional accessibility that invites community members to engage with services with a sense of belonging and safety.

The emphasis on investing in the early years’ workforce is underscored by a unanimous call for wage parity and robust investment in the sector. This extends beyond mere financial remuneration, infiltrating realms of recognising and valuing the intrinsic role of early years' workers in shaping future generations. Thus, strategies involving family scholarships, equitable opportunities, and facilitating an environment that fosters quality and equity within early years' spaces are crucial.

Communication and support networks materialise as foundational in facilitating services where families feel well-informed, supported, and empowered. It's pivotal to formulate communication and support frameworks that are intertwined with the cultural and communal narratives of the Aboriginal communities, wherein elders and community leaders play a vital role in endorsing and guiding service utilisation.

The notion of infrastructure development, particularly through the creation of one-stop shops or comprehensive service hubs, illuminates a pathway toward simplifying and enhancing access to diverse services for families. A successful framework would thus encapsulate a comprehensive, accessible, and navigable network of services that proactively cater to varied needs from early childhood to parental support.

Lastly, defining success within the framework demands a confluence of tangible outcomes and community perceptions. While wraparound, Aboriginal-led and determined services serve as tangible objectives, success must also be measured through community members' empowerment, familiarity, and comfort within these services, embodying a framework that is not just delivered to but is also co-created with the community.

Each of these issues, underscored by the real and shared experiences of community members and workers within the sector, necessitates a nuanced, consultative, and culturally safe approach in crafting a VAEYHF. It is this meticulous amalgamation of insights, perspectives, and collaborative strategies that will culminate in a framework that is both deeply resonant and effectively transformative for Aboriginal communities across Victoria.

Conclusion

The virtual consultation provided a clear scope of challenges, aspirations, and actionable insights necessary for the formulation of an Aboriginal Early Years Health Framework. This Framework, as envisioned, isn't just robust but profoundly rooted in principles of cultural safety, accessibility, and empowerment of the community. Drawing from the diverse discussions and insights amassed during the online consultation, it's evident that there's a compelling need for services and strategies which are culturally grounded, seamlessly integrated, and firmly supportive of the Aboriginal children and families in Victoria. As we move forward, this consultation beckons a deeper exploration and sustained engagement with both communities and professionals. This approach is essential to co-designing pathways that not only respect and honour these insightful discussions but also propel towards a brighter, enriched future for Aboriginal children and their families in Victoria.

Next Steps

Building on the collective insights and reflections, the subsequent phases will focus on the pragmatic development and fine-tuning of the Victoria Aboriginal Early Years Framework. The discussions underscore the importance of a comprehensive, cohesive, and culturally sensitive approach. It's vital that these insights serve as a bedrock, guiding the creation of strategies and initiatives under the framework. These should not only exude empathy but also be effective in addressing the distinct needs of the Aboriginal communities in Victoria. The journey ahead promises collaborative co-creation, continuous learning, and an unwavering commitment to the cause.

Table of Issues as Discussed in the Workshop

Executive Summary

This comprehensive report encapsulates the rich insights and discussions arising from the Workshop and Forum held on October 12th, 2023, at Nairm Marr Djambana. The primary objective of this gathering was to inform the development of a comprehensive VAEYHF, a crucial initiative aimed at improving the quality and accessibility of early years healthcare services for Aboriginal children and families. Participants included early years health professionals and parents and carers of Aboriginal children, who shared their experiences, challenges, and aspirations for a more inclusive and culturally sensitive early years healthcare system.

Introduction

In the pursuit of health equity and the fulfillment of our commitment to the Aboriginal communities, the creation of a VAEYHF supports culturally sensitive healthcare for First Nations families. The Workshop and Forum conducted on October 12th, 2023 at Nairm Marr Djambana, marked an influential component in this process.

Key Findings and Recommendations

The Workshop and Forum were instrumental in uncovering key challenges and promising avenues for the development of the VAEYHF. The following are critical findings and recommendations.

1. Deficit-Focused Promotional Material: Participants expressed deep concern over the pervasive deficit-focused promotional material related to health services. Such materials inadvertently stigmatise Aboriginal communities, undermining their trust and engagement with these services. The need for a paradigm shift towards empowering, culturally sensitive messaging is evident.
2. Synonymous Notion of Aboriginality and Vulnerability: A concerning revelation emerged during the discussions: mainstream services often conflate Aboriginality with vulnerability. This stereotype not only diminishes the sense of self-worth and dignity of Aboriginal individuals but also contributes to a cycle of inadequate care. Efforts must be made to eliminate this harmful association, and mainstream services must be educated about cultural sensitivity. Even further, services should adopt strengths-based language that supports the aspirations of children, parents, and families.
3. The Need for a Dedicated Framework: The resounding call for a dedicated VAEYHF echoes the dire need for change within the healthcare system. Participants highlighted several compelling reasons, including the ongoing service deficits, a pervasive sense of not being cared for in mainstream services and workplaces, and the overarching belief that the entire healthcare system requires a fundamental overhaul. Dealing with issues surrounding identity, which encompasses emotional and complex factors, requires a holistic framework. The question remains, will the Framework be successful in offering a decolonised service within a colonial, mainstream system?
4. Unborn Child Protection Notification: A significant barrier to accessing early years health services is the process of unborn child protection notification. This process is perceived as intrusive and has the potential to create immediate barriers to engagement with healthcare services. It is imperative that this process be reviewed and restructured to foster trust and cooperation.
5. Importance of Language: Language, both in written and spoken form, emerged as a critical factor in healthcare engagement. Overly complex, and/or colonial language can perpetuate stigma, confusion, and misunderstandings. Hence, the imperative to adopt user-friendly, culturally sensitive language that respects Aboriginal ways of knowing, being, and doing is critical.
6. Challenges in Self-Identification: Another poignant observation was that Aboriginal peoples do not always identify themselves as such within the mainstream health system. Stigma and discrimination play a significant role in this self-concealment. Initiatives aimed at dismantling these barriers and fostering an environment of inclusivity are indispensable.
7. Cultural Connection and Communication: The role of Aboriginal workers in facilitating conversations about available culturally safe early years services cannot be overstated. Longer appointment times are necessary to create the space for discussions about health that are trauma-informed, patient-centred, and culturally sensitive. Ensuring appointments encompass elements such as choice, respectful treatment, effective communication, connection, and consistency of care is essential.
8. Desired Experience for Aboriginal Families: A recurring theme throughout the discussions was the pursuit of an ideal decolonised experience for Aboriginal parents, families, and children. This experience includes user-friendly language, respectful treatment, effective communication, and the assurance of continuity and consistency of care.
9. Measuring Outcomes: The Framework's success must not be measured solely through clinical metrics. It is equally vital to assess outcomes against social and emotional outcomes, recognising the holistic nature of health.
10. Support for Carers: An often-overlooked issue is the support required by grandparents who take on the role of primary caregivers. They are not always entitled to maternal child health appointments, and this oversight should be rectified.
11. Enhanced Communication: Participants emphasised the urgent need for clear and accessible communication regarding available services. It is essential that Aboriginal families are fully aware of the resources at their disposal.
12. Integration and Collaboration: Playgroups emerged as a critical component of early years health services. There was a strong call for more integration of parenting and child services. Collaborative efforts between organisations, including hospitals and Aboriginal Community Controlled Health Organisations (ACCHOs), were recommended to streamline service delivery and enhance the quality of care.
13. Cultural Competency of Mainstream Service Providers: Participants stressed the importance of mainstream service providers being culturally aware and competent. A deep understanding of the unique needs and wants of Aboriginal children and families is fundamental to delivering effective care.
14. Consistency and Information Distribution: Participants underscored the need for consistency in service provision. Additionally, the distribution of informative booklets or websites detailing available services was considered crucial to ensuring that families have the necessary information at their fingertips. The challenge of knowing what services are available emerged as a significant concern. This calls for a comprehensive effort to communicate available services clearly and transparently to parents and families.
15. Support Post-COVID: Post-COVID, support from services appeared to have diminished, possibly due to funding constraints. It is essential to explore avenues for sustaining and expanding support for Aboriginal early years health services.

Barriers

During the workshop, the following barriers were discussed:

Aboriginal families face several barriers in accessing early years health care, which significantly impact their well-being. One primary issue is the insufficient utilisation of '715' health assessments. These assessments are critical in early detection and management of health issues, yet they are not consistently accessed by members of the community, possibly due to a lack of awareness or accessibility.

Another significant barrier is inadequate sexual health promotion. Sexual health is a crucial aspect of overall health, and the lack of targeted, culturally sensitive sexual health education and services hinders the ability of Aboriginal families to receive comprehensive care in this area.

Geographic differences in service access also poses a major challenge. Travelling to different locations to access different services presents a challenge for families. This geographical disparity means that many Aboriginal families face other logistical challenges to access basic health care services.

Lastly, there is a perception among parents in these communities that they may be judged or discriminated against in Maternal Child Health services. This fear of judgment can discourage them from seeking necessary health care, leading to a lower rate of engagement with these services and, consequently, a gap in essential health care during the early years.

These barriers collectively contribute to the health disparities faced by Aboriginal families and underline the need for culturally sensitive, accessible, and equitable health care services.

Enablers

Several enablers that facilitate access to adequate early years health care for Aboriginal people were discussed in the workshop, contributing to better health outcomes and community engagement. These enablers play a crucial role in overcoming the barriers often faced in accessing health care.

One significant enabler is the implementation of youth programs and interventions. These initiatives are specifically designed to cater to the needs of young Aboriginal families, providing tailored health education and services. These programs often focus on preventative care and early intervention, which are key in managing health issues from a young age.

Another enabler is the incorporation of cultural overlays in health care services, such as those found at Gathering Places. These culturally enriched environments make health services more welcoming and relevant to Aboriginal families, ensuring that care is delivered in a culturally sensitive and respectful manner.

Incentivising '715' health screenings with gift cards or other incentives has also proven to be an effective strategy. This approach encourages families to participate in these important health assessments, which are crucial for early detection and management of health issues.

Fostering sexual health promotion tailored to the needs and cultural contexts of these communities is another key enabler. By providing relevant and respectful sexual health education, families are better equipped to make informed decisions about their sexual health.

Encouraging participation in yarning groups is a powerful tool in health promotion. These groups provide a safe and familiar space for families to share stories, experiences, and knowledge about health, fostering a sense of community and mutual support.

Lastly, providing choice in health care services is critical. Allowing parents to choose whether they access mainstream or Aboriginal-led services empowers them to make decisions that best suit their needs and preferences, leading to greater satisfaction and engagement with the health care system.

These enablers highlight the importance of culturally appropriate, accessible, and community-driven approaches in delivering health care to Aboriginal families, ensuring better access and engagement in early years health care.

Conclusion

The Workshop and Forum held on October 12th, 2023, have been a pivotal moment in the journey toward a more inclusive and culturally sensitive early years healthcare system for Aboriginal children and families. The insights and recommendations presented in this report offer a roadmap for the development of the VAEYHF. These findings must be translated into actionable policies and practices to ensure equitable access to healthcare services.

Introduction

Karabena Consulting extends its gratitude to the committed professionals who participated in the workshop on October 13th, 2023. Their insights into the challenges and opportunities within the realm of early years health services for Aboriginal children and families are invaluable. The gathered knowledge is foundational for developing the VAEYHF, and to taking a step towards decolonising health services so that they are accessible, culturally responsive, and provide appropriate support to families.

Challenges and Current Experiences of the Early Years Health System

Child Protection. Interaction with child protection services is a dominant concern. The involvement of these services can oftentimes add layers of complexity, necessitating a patient, bespoke approach to health care delivery for these families. Due to systemic racism and inherent deficit-lens within the colonial health care structures, parents are less likely to present to early years health services for fear of being flagged with Child Protection services.

Services in Eastern Region of Melbourne. The east of Melbourne presents an exceptional challenge. Unlike other regions, Aboriginal services are often disparate and/or divided from each other, leading to potential overlaps and, worse, gaps in essential services. This can also make accessing various services challenging where they are located in different locations of the eastern region, and lack coordination and communication between services.

Service Understanding and Engagement. Effective healthcare is grounded in understanding and trust. The 'why' behind certain health checks must be transparent (e.g. developmental and milestone checks in MCH services), ensuring that the community members don't feel alienated or intimidated. Regrettably, many mainstream services sometimes seem more interested in fulfilling bureaucratic requirements than in delivering genuine care. Again, due to the systemic deficit-lens imposed on Aboriginal families, this can result in disengagement from scheduled check-ups and appointments.

“Let Mob do their own health and we know we'll get amazing outcomes.”

Funding and Coordination. Funding represents a multi-faceted challenge. With a significant portion directed towards mainstream sectors, there's a pressing need for an all-encompassing health funding pool. Ideally, this would ensure that ACCHOs and ACCOs have priority access to funding for early years health services and programs delivered to Aboriginal children and families. In turn, this would promote collaboration and comprehensive care between ACCHOs/ACCOs and mainstream service providers, and reduce hegemony of mainstream services over funding.

Capacity and Training. Investing in the professional development and well-being of staff is non-negotiable. It is alarming that many children, rather than receiving comprehensive care, are being hastily diagnosed and medicated, particularly relating to autism and ADHD. Often, what is treated as a quick-fix solution through medicating overlooks the actual issues of trauma as a root cause. This speaks to the need of trauma-informed care training to be embedded within mainstream services so that children are not mis-diagnosed and unnecessarily medicated. Furthermore, there is a need to build the workforce capacity of Aboriginal staff so that families have the choice to be treated by an Aboriginal health professional, who will understand the underlying social and cultural determinants of health. This will contribute to more accurate diagnosis and more appropriate treatment for SEWB.

Systemic Concerns. A significant systemic barrier is the deficit-focused lens through which Aboriginal people are often viewed. This stigmatised perspective contributes to apprehension about identifying as Aboriginal within health institutions, meaning appropriate support is not always provided. Furthermore, it can contribute to further disengagement from the early years health system.

Financial and Infrastructure Constraints. Financial challenges are pronounced in the eastern region. Though funds flow into services, a palpable disparity exists when it comes to infrastructural development and delivery mechanisms. Whilst programs and services may be funded, adequate infrastructure to deliver them is not consistently available due to challenges such as exorbitant rent. Funding designated early years hubs, and/or focusing on delivering visiting services through play groups is one step to alleviating this challenge.

Suggestions and Recommendations

Integrated Services. Health services should move beyond conventional paradigms. Playgroups, for instance, offer a relaxed setting for health integration, bridging gaps and fostering community relationships. Similarly, parenting services, when closely knitted with hubs like Maternal and Child Health and Paediatrics, can streamline care and foster holistic child development. Looking for opportunities to align early years health services with play groups, parenting groups, and hubs can empower parents to access appropriate care through a more welcoming and supportive environment. Having parenting services attached to identified hubs that could include KMS, MCH, child and family health, paediatrics, and youth clubs would be ideal.

“The East is the least funded area in the State.”

Access to Funding. A proactive approach is essential to ensure funds are not just allocated but also accessible and utilised optimally. Transparent mechanisms and reduced bureaucratic hurdles can make this a reality. Prioritising funding for Aboriginal-led organisations to deliver services to Aboriginal families is essential, as well as reducing the monopoly mainstream services have on the early years health system.

Information and Data Sharing. Collaborative efforts can only thrive in an environment of transparency. It's imperative for Government Departments to foster a culture of shared knowledge, making strides towards cohesive service delivery. Reducing the siloing of funding, and ensuring an interdisciplinary approach to early childhood will contribute to more responsive and thus effective support for families.

Framework Inclusion. For this Framework to be reflective and effective, it should be referred to evaluation and monitoring by bodies such as the Aboriginal Health and Wellbeing Partnership Forum. Additionally, revisiting the guidelines and distribution of the Aboriginal Best Start Funding can ensure more targeted, effective, and efficient delivery of early years services.

Addressing Diversity. Melbourne's Aboriginal population is a mosaic of cultures and histories. This rich diversity, while a strength, also necessitates a nuanced approach to ensure health services cater to the unique needs of different members of the community. A focus on fostering a strong ‘identity’ among young children should be embedded within the Framework, with culture being one aspect of this identity. This accounts for the fact that many Aboriginal families in Melbourne may be disconnected from culture due to the legacy of colonisation. Therefore, focusing on ‘identity’ can reduce the shame and guilt associated with cultural disconnection, and create a more supportive atmosphere that is accessible.

Enablers and Barriers

Enablers. Key mechanisms can lead to positive change. Comprehensive health checks, like the 715s, universal Medicare access, and dedicated funds for early years health are pivotal. Therefore, ensuring that families are supported and incentivised to access available health checks and screenings is a core enabler. Creating relaxed maternal spaces, sexual health clinics, and ensuring that family-centric wrap around services can transform health outcomes.

Barriers. Challenges persist in multiple forms. From a troubling trend of 'lazy referrals' to the harrowing experience some face in hospitals, where the environment is perceived as unsafe, these barriers demand attention. Moreover, competition among services and staffing challenges, especially within Aboriginal Community Controlled Organisations, highlight the pressing need for a comprehensive workforce strategy. Building the capacity of the workforce in ACCOs and ACCHOs through recruitment and retention is critical, as well as the capacity of mainstream services to provide patient-centred, trauma-informed care.

Conclusion

The COVID-19 pandemic illuminated the vulnerabilities within our early years health system, amplifying the necessity for structural and systemic changes. Through the insights gathered in the workshop, we're presented with key elements that can contribute to the development of the Framework. While many challenges exist, the collective will and knowledge of the community and professionals offer hope. Karabena Consulting remains dedicated to steering the journey towards a more inclusive and effective VAEYHF, ensuring happier and healthier futures for Aboriginal children and families.

Executive Summary

The purpose of this report is to summarise the key Stakeholder Workshop themes and findings, and provide insights and recommendations for the development of the VAEYHF. Derived from a workshop at the Wunggurrwil Dhurrung Centre, this report aims to create a holistic understanding of the needs, challenges, and solutions pertinent to early years health services.

Definition of Aboriginal Early Years

From the responses during the workshop it was determined that the Aboriginal Early Years specifically refers to the integral stage from pre-conception up to five years of age. This period is pivotal, not only for physical health but also for cognitive, social, and emotional development. It signifies the time where foundational health and well-being practices are established, and where the first touchpoints with health services often occur.

Key Insights

Role of Centres Like Wunggurrwil Dhurrung. Centres such as Wunggurrwil Dhurrung play a dual role: they act as sanctuaries offering safety and comfort, while also providing an environment conducive for early learning and health guidance. Their significance goes beyond mere physical spaces; they symbolise cultural affirmation and collective community spirit. As stated by a health professional, “They [families] feel good when they come here”.

Outreach and Engagement. Historical and ongoing systemic challenges may lead to hesitancy or distrust towards institutional services. Hence, taking services to families, instead of expecting them to come to the centres, bridges this gap. Outreach is not just about location; it's about cultural alignment, comfort, and building trust.

Workforce Challenges. The vacancies across roles reflect the broader challenges in recruiting and retaining professionals in Aboriginal health settings. Addressing these gaps is not only about filling positions but ensuring these roles are filled by individuals who resonate with the community's values and needs.

Cultural Safety and Affirmations. Cultural safety practices, like using possum skin for weighing infants during Maternal and Child Health appointments, demonstrate a profound respect for traditions and fosters a connection with culture, that may have been disconnected for many families due to the destructive legacy of colonisation. Such practices, complemented by affirmations, reaffirm the importance of integrating traditional methods with modern health practices.

Empowerment and Responsibility. Parental empowerment goes beyond providing choices; it's about instilling a sense of agency and responsibility. Parents need to feel they are active participants in their child's health journey, not mere recipients of advice. Furthermore, it is integral to use strength-based language that focuses on parental strengths, as opposed to deficits.

Advocacy and Services Navigation. Navigating the myriad of early years services can be daunting. Advocates act as bridges, providing guidance, clarifying doubts, and ensuring families maximise the benefits available to them. This may occur, for instance, through administering maternal and child health services during playgroups.

Governance and Funding. Transparent governance and accessible funding are the backbones of efficient service delivery. Without clarity, services may suffer from inconsistencies, potential overlaps, or gaps.

Engagement with Health Appointments. The commendable attendance rate of families, including fathers, in the Wyndham Vale region indicates a community keen on active participation. This contradicts some stereotypes and emphasises the importance of localised engagement strategies.

Cultural Activities. By hosting activities like traditional dance classes, centres become more than health hubs. They evolve into cultural preservation and celebration spaces, enriching the community's sense of identity. This is one of the key hallmarks of Wunggurwil Dhurrung.

Financial and Administrative Barriers. Operational challenges, such as applying for grants, can detract from the core focus of health service delivery. Reducing these barriers can accelerate the pace and expand the breadth of services.

Recommendations

• Outreach Programs: Expand outreach programs and tailor them to meet the cultural and logistical needs of families.
• Workforce Development: Implement comprehensive programs to train and immerse graduates in Aboriginal health contexts, ensuring they resonate with community values.
• Cultural Activities: Invest in and incorporate more cultural events, ensuring they are authentic and community-driven.
• Streamline Governance: Develop clear guidelines regarding funding, accountability, and resource allocation.
• Direct Funding: Simplify the process by which initiatives such as ‘Welcome Bubup to Country’ receive funding, potentially offering direct funding routes to reduce administrative burdens.

Incorporating these insights will not only aid in creating an effective VAEYHF but will also ensure the holistic well-being of the Aboriginal children and their families.

Parent and Carer Forum Summary

Introduction

The central aim of this Forum was to capture the unique perspectives and experiences of Aboriginal parents and caregivers regarding Early Years Health Services. By collecting these invaluable insights, we can better shape the VAEYHF. The primary objective of this report is to collate and present the feedback obtained during the forum, all of which gravitates around the central question, “What are the Aboriginal Early Years?”

Major Themes and Insights

The Experience of Parenting and Foster Care. One participant's heartfelt declaration, “The biggest miracle of my life is to be a VACCA foster parent,” underscores the profound pride and reverence associated with caregiving roles within this forum, where a diverse range of experiences was represented. This also spoke to the challenge of the Framework to respond to these diverse experiences, as this carer is not entitled to MCH support.

Safety and Trust in Health Services. The community seeks more than just perfunctory services; they yearn for health services rooted in trust and safety. An alarming sentiment emerged from a participant who shared, “I always feel like I am one report away from having my child taken away.” The worrisome perception that official procedures may serve as modern tools for ongoing discrimination and separation resonated with many, summarised by the remark: “a lot of this still goes on, but just framed in an official, ‘legal’ way.”

Legacy and Intergenerational Trauma. The experiences of the Stolen Generations and the accompanying intergenerational trauma linger on, shaping the lived experiences of present-day Aboriginal families. It's imperative to both acknowledge and address the ongoing legacy of trauma. This can also engender parents and carers with distrust of mainstream health services, and speaks to the need to ensure cultural safety in all early years health services.

Socio-economic Struggles. Many participants accentuated their ongoing battles with stable housing and the rising cost of living. Such socio-economic pressures compound the already existing stresses and strains on families, and can create a barrier to accessing early years health services.

Interaction with Health Professionals. A considerable portion of attendees recounted instances where they felt judged or evaluated by health professionals catering to the early years. This unsettling feeling was captured by a participant who likened it to “walking on eggshells.” Again, it is critical to ensure that culturally safe care is consistently applied across all early years health services.

Importance of Community Hubs. Community hubs, like the Wunggurrwil Dhurrung Centre, engender feelings of security and belonging amongst families. Beyond just fostering community, these centres can assist in facilitating access to early years health services, pivotal health screenings such as the 715s. However, the execution of the 715 health check is crucial; as voiced by a participant, “If it's not done by the right person, it's a mess. It can be awful.” An initiative by BADAC, involved offering a Coles voucher to those attending the 715 check, saw a noticeable uptick in participation.

Comprehensive Health Needs. The community fervently feels the need for a more holistic approach towards early years health that includes risk prevention, contraception, youth health, and sexual health.

Administrative and Identification Concerns. Accessing NDIS funding appears to be a daunting and prolonged affair for many. A recurring issue pertained to the sense of judgement and doubt when individuals disclosed their Aboriginal heritage in mainstream settings. As one participant aptly put it, “We'd rather go to an Aboriginal organisation.”

The Wunggurrwil Dhurrung Centre embodies the potential of what can be achieved when individuals are provided with a nurturing, judgement-free environment. The resounding sentiment from attendees was a palpable feeling of safety and acceptance, as they expressed that they felt “safer here” and took solace in the fact that “nobody judges here.” The insights curated in this report emphasise the need for a comprehensive, culturally responsive, and trauma-informed Early Years Health Service. A service that truly prioritises the well-being of Aboriginal children and their families.

What Works and What Doesn't Work in Aboriginal Early Years Health

The following responses were derived during brainstorming activities conducted with parents and carers:

What Works

1. Communication: Clear and open communication is paramount for ensuring trust and understanding between service providers and Aboriginal families.
2. Cultural Education: Providing education that incorporates and respects the rich tapestry of Aboriginal cultures is instrumental in fostering understanding and bridging gaps.
3. Unique Services for Aboriginal People: The suggestion of integrating pop-ups into Medical Program Software to alert medical professionals about patient eligibility for AHA and CTG is an innovative measure to ensure tailored care.
4. Multi-generational Support: Embracing the importance of family and the integral role of multi-generational support ensures a cohesive support structure that honours tradition and wisdom, and broader family units.
5. No Judgement: It's crucial for service providers to approach care with an open heart and mind, ensuring families feel understood and respected.
6. Rapport: Building a genuine and trusting relationship with families can significantly enhance the quality of care and communication.
7. Aboriginal Support Workers: The presence of dedicated support workers who understand and share the cultural background of families provides a unique layer of trust and relatability.
8. Outreach: Ensuring services are accessible to all, regardless of location or mobility, is essential for comprehensive care.
9. Safe Places: Recognising and promoting Aboriginal Organisations and Agencies as safe and welcoming environments is pivotal for community trust and participation.
10. Aboriginal Staff: Employing Aboriginal staff ensures a deep-rooted cultural understanding and creates a sense of belonging for families accessing services.
11. Culturally Safe Learning in Kindergartens: It's vital that early education respects and incorporates Aboriginal perspectives, ensuring children grow in an environment that honours their heritage.
12. Knowledgeable Service Providers: Providers equipped with a deep understanding of both medical and cultural nuances can offer more precise and respectful care.
13. Yarning Groups: These provide a community-centric platform for sharing, understanding, and learning in a culturally respectful manner.

What Currently Doesn't Work

1. Emotional Supports for Fathers: It is evident that there is a significant reluctance among fathers to discuss traumatic experiences. There's a paramount need to develop dedicated emotional support mechanisms tailored to their needs.
2. Repetitive Solutions: The repeated attempts to “reinvent the wheel” rather than building upon existing frameworks or solutions are neither efficient nor effective. We need to focus on strengthening and iterating upon proven methods.
3. Relaying Traumatic Histories: Parents and carers expressed the emotional strain of having to recount traumatic histories to every new professional they encounter in the early years health journey. This not only heightens their distress but also results in inconsistencies in the relay of information.
4. Overlapping and Unaccountable Services: There are concerns about the unclear demarcation between services, leading to overlapping responsibilities. This absence of clear ownership often results in missed opportunities for intervention and support.
5. Challenges for Carers: Embedded racist attitudes have had a significant impact on the experiences of children in educational settings. These need to be addressed head-on to prevent further complications in the child's development and overall well-being.
6. Professional Trust Deficit: There is a noticeable lack of confidence in the competencies and understanding of health professionals, underscoring the importance of specialised training and cultural sensitivity.
7. Inadequate Grief Counselling: The absence of family advocates in grief counselling settings has been detrimental. Such advocates are essential in ensuring that the family's needs and concerns are at the forefront of any intervention.
8. Gap in Doctors' Knowledge: Doctors (GPs) need to be better equipped with knowledge about the unique health challenges and histories of Aboriginal communities. This will ensure more holistic and effective health solutions.
9. Lack of Aboriginal Representation: The conspicuous absence of Aboriginal staff or Aboriginal Liaison Officers in early years health settings is concerning. Such representation is pivotal for culturally appropriate service delivery.
10. Limited Awareness of Health Check 715: There is a worrying lack of knowledge among doctors about the 715 health check, an essential tool for Aboriginal health assessment.
11. Discrimination in Health Services: Reports of hospitals and specialists declaring their inability to assist upon identifying a patient's Aboriginal heritage are deeply alarming and need urgent redress.
12. NDIS Accessibility: The National Disability Insurance Scheme (NDIS) has been highlighted as both challenging to access and navigate. Adjustments are required to make this vital service more accessible and user-friendly for Aboriginal families.

What will help you feel more supported as a parent/carer

Overwhelmingly, parents and carers reported the desire to receive more support, positive support, and more cultural support so they can feel connected and have a strong sense of belonging. This will help foster a strong sense of identity amongst both them and their children.

Stakeholder Workshop Summary

Introduction

This section of the report encapsulates the collective insights derived from the Stakeholder Workshop on 20th October 2023 at Barrbunin Beek Aboriginal Gathering Place. Organised by Karabena Consulting, the workshop engaged early years health professionals from the City of Whittlesea, VAHS, and Banyule Community Health. Guiding the Workshop was the central question, “What are the Aboriginal Early Years?”, with the overarching aim of guiding the formulation of the VAEYHF.

Key Themes and Findings

Holistic Health and Service Delivery. A pivotal theme arising from the workshop was the strong preference for holistic health practices. Participants underscored the merit of a “one-stop-shop” approach to early years health services like immunisation and maternal child health where “everything can be done at the same time”. The benefits of such a model lie in its capacity to diminish the complexities and fragmentation experienced by families while accessing diverse health services.

It was stated that “families don't have time to go to different places”. One key opportunity was the role of play groups in providing a key contact point to integrate early years health care in a relaxed and accessible way. Within this model, health care would focus on the whole person, the whole child, and encompass parenting support such as coaching. It is especially difficult to attend an appointment with a large family, and combating the pressures of the ‘Colonial Gaze’ in mainstream healthcare.

Challenges and Barriers. The workshop participants brought to light multiple challenges within the current health system:

1. Accreditation and Training: There exist discrepancies in procedures and standards, especially concerning cold storage for vaccines and staff training.

“It is hard to do opportunistic vaccinations, especially during home visits. Only a few places in the north of Melbourne can store vaccines and we don't want to waste them. It would be hard to maintain the integrity of the vaccines and that is why we can't take them around with us... another issue is who is trained to provide vaccines…”

2. Parental Challenges: Families, especially those with several children, find it increasingly difficult to navigate and access health services while catering to each child's unique needs.

“I have to give sleep medicine to my two older children so I can deal with my two younger ones, if our routine is thrown out then it is much harder to do what needs to get done in my personal life, especially now as I am working part time.. it would be good if there was a child care centre at health clinics so I could go there and know my older two were being looked after while my younger two get the help they need…”

3. Funding and Resource Allocation: The present funding model creates competition between services, meaning funding does not always meet the needs of services or families. For instance, Banyule Community Health is not entitled to certain funding because its LGA encompasses high-socioeconomic areas such as Ivanhoe. Banyule cannot access Best Start funding or Connected Beginnings funding. Furthermore, there was a key complaint that many programs are funded for twelve months so there is no security and longevity, and it is difficult to get programs up and running.

“Please recognise the ‘pockets of high need’ in funding decisions, even though we are surrounded by wealthy neighbours, this does not translate to every Aboriginal person having the same experience as people who live in Ivanhoe…”

4. Post-COVID Environment: The aftermath of the pandemic has intensified existing issues, from increased health problems due to service gaps and associated workforce pressures, and a skewed focus on tertiary driven service delivery, rather than effective early intervention. Distinct barriers in accessing General Practitioners have been observed, a situation worsened in the aftermath of the COVID-19 pandemic. Notable delays and challenges were reported concerning paediatric services, with an apparent need to bolster access to paediatricians and corresponding specialists. The current underfunding of mental health services is resulting in complications in recruiting specialist personnel.

“My son needed psychological services and it is only because I am a worker in the area that I was able to ring 48 different psychologists to get him in earlier than the 15 week waiting period that was offered to him. That is the issue, we have quick assessments done, and then months of waiting to see a specialist… allied health staff (OTs and Speechies) are impossible to access…”

Coordination and Engagement. Participants voiced the need for coordinated care, envisioning a system free from competition, where collaboration ensures a 'no wrong door' policy. Coordinators, often undervalued, serve as the linchpin connecting services, families, and communities, a role that goes beyond mere logistics. Additionally, a gap persists when families disengage, and the onus falls on services to rebuild this connection. Often, there is a protocol whereby services attempt to engage via one method and a finite number of times. A coordinator or advocate may assist to increase continuity of engagement with early years health care. Transition moments, such as shifts in health workers or postnatal care, are seen as potential stress points for mothers, especially those grappling with challenges like postnatal depression.

“I have been living in refuges for a long time and finally got a place near to the centre here…It's my first time connecting to a community organisation like this one but I feel safe here. People don't judge me and this is very important as my kids are known for child protection. When I had my daughter my partner dropped her in the hospital and I was there for at least 10 days with her, before we were allowed to leave. Even though he is not supposed to see us at the house, he does…but it is good to know I have some support around me through the centre..”

Cultural Understanding and Integration. The existing dichotomy between mainstream and Aboriginal-led health services highlights the glaring inconsistencies in accessing culturally responsive and safe care in early years health services. Too often, mainstream services apply a deficit-lens to care, or what was described as the “Colonial Gaze” and participants spoke to the need for a greater adoption of trauma-informed, strengths-based approach to care in mainstream services.

“As soon as I said I was Aboriginal the nurse asked how much alcohol I was drinking…I told her I was a non-drinker, but I didn't go back…”

Furthermore, the participants spoke of the significant merit in weaving Aboriginal customs into parenting programs, fostering a more inclusive environment that focuses on strengthening identity, where families may have previously felt disconnected from culture.

“..would be nice to know how to be a parent to my Aboriginal children. My partner is Aboriginal but he was using and my parents, both school teachers ended up having our children removed from us into their care until he cleaned up or I promised that I would leave him. We ended up getting the kids back, but he doesn't know his culture. It's not like there are a lot of family fun days anymore, but places like this where we can yarn, weave and be outside near the fire is good for us…”

Challenges in Resource Allocation. Proximity and community size have emerged as determining factors in accessing beneficial programs. Larger organisations often overshadow smaller Aboriginal organisations, leading to an unfair distribution of resources. Participants called for greater equity in access to funding so that services can be consistently delivered to all Aboriginal families across the region.

“I feel much more comfortable in a playgroup to ask the MCH nurse or Kristen about where I can go and what I can do next…”

Aboriginal Early Years. A notable suggestion was integrating the new 15-hour allocation for three-year-old kindergarten into a universal health pathway, fostering collaborations between health and education sectors. As part of this 15-hours, early years health services could partner with kindergartens to provide accessible screenings and care.

“Yeah, maybe this could work. I don't know what check-ups could be done during kindergarten or whether it will be worth it, I can't get an OT now so not sure what the benefit would be…”

Trust and Transparency. A noticeable finding that emerged was the distrust towards the health system, especially among single-parent families. There are instances where the fear of potential repercussions on their children deterred individuals from seeking medical assistance. For instance, fear of child protection intervention if Aboriginal children are not developing as expected or present with a health issue was expressed as a particular barrier to accessing early years health.

“If I don't go to a paeds appointment, then I get CP calling.”

Again, this spoke to the prevailing deficit-lens that is often projected within mainstream services. One key concept that emerged from the workshop was the metaphor of a ‘trust baton’, where a key point of contact can develop trust with families, and pass the ‘trust baton’ to other services involved in care.

“I trust Kristen, Aunty Sharon and the team here, if they say that someone else is ok, then I will trust them.”

Community Engagement and Digital Transition. There's an evident shift towards online platforms for discussions around child development, providing new parents with a forum to share and learn. However, face-to-face interactions still hold paramount importance. Daycare and playgroups also emerged as trust-building entities, where parents can engage in early years health care in a relaxed and supportive environment, easing concerns about child development and distrust about health services.

“Sometimes it would be good to have a FB group where we can find out about events and things, but I still like coming to the centre for me…”

Food Security. Food security concerns were prominent, with an increasing number of families seeking assistance due to cost-of-living pressures. Initiatives like community pantries and food banks, such as that run by Barrbunin Beek, were discussed as potential solutions. This would be one strategy to ensure children are receiving adequate nutritional health.

“This week we delivered over 79 food boxes to families across our area, we are getting more phone calls every day that the cost of living is too high and we are doing more. This was meant to be a one-off program, and now we are continuing it for the foreseeable future…”

Recommendations

Early Detection and Engagement

1. Early Screening: There is a need to prioritise early identification and prevention. To ensure developmental delays are identified and addressed promptly, it's imperative to implement effective engagement in developmental screenings. It was recommended that to increase engagement this could occur within daycares, playgroups, and early childhood centres.

• Parents as first health responders - engaged in providing health care for their children and having access to the necessary health hardware to do this work.
• Clearer and more culturally appropriate roles and responsibilities for parents and carers and male and female carers in supporting their children reach their development milestones as part of structured activities in playgroups etc.

2. Engagement Strategies: Recognising the significance of continued support, strategies ought to be formulated to reconnect with families that have disengaged from services. Such strategies will ensure that no child misses out on essential support due to temporary disengagement. Outside of integration of early years health with early childhood centres and playgroups was increasing the scope of outreach programs (“you've got to be where the people are”). It was highlighted that a lot of parents are anxious about what they are doing right, but more importantly what they are doing wrong.

Cultural Integration and Digital Outreach

3. Incorporating Cultural Elements: For the holistic development of Aboriginal children, programs should be devised to seamlessly integrate cultural teachings. This not only nurtures a robust sense of identity and belonging in children but also reinforces cultural continuity.

4. Digital Integration: While the significance of in-person interactions remains paramount, it is equally essential to harness the potential of digital platforms. Such platforms can serve as a bridge, connecting and supporting parents, particularly those grappling with feelings of isolation.

5. Raise Awareness: Effective communication channels need to be strengthened between health professionals, childcare centres, and families. This ensures that parents know and understand the range of services that are available to them, and know how to access them.

Collaboration and Access

6. Collaborative Approach: The adoption of a “no wrong door” principle is crucial. This ensures that parents, regardless of their entry point into the health system, experience consistent, comprehensive, and coordinated care. The importance of midwives, MCH nurses, and the extended team working with families was emphasised. A strong recommendation emerged advocating for intensified collaboration between health professionals and family counselling services, especially for households confronting challenges such as family violence.

7. Strengthen Collaboration: Coordinated collaboration between various early years health services is crucial to ensure Aboriginal families experience a smooth and integrated health journey. This extends to the State and National Departmental level, where at the moment funding is often too siloed which contributes to the disconnect between relevant services.

8. Address Access to Services: Proactive strategies to diminish waiting times and bolster access to essential services, including general practitioners and specialists, are crucial to ensuring timely care. One key suggestion to ensure increased coordination and integration of care was to have daycare centres attached to ACCHOs.

Cultural Understanding and Worker Support

9. Cultural Training: A genuine understanding of Aboriginal experiences and perspectives can be enhanced through comprehensive cultural training for health professionals, ensuring trauma-informed care for families.

10. Professional Support: Given the critical roles health workers play, it's essential that they are provided with the capacity to engage in ongoing professional development, requisite support, and due recognition.

Empowering the Community

11. Serving Parents & Carers: The voices of parents and carers should be the cornerstone upon which health strategies are developed. Ensuring that these strategies resonate with their needs and concerns will make for a more effective and inclusive health system.

Measures of Success

• There is consistent funding support
• There is a shift from competition to coordination of services and funding
• Culture is viewed as a protective factor in both Aboriginal-led and mainstream services
• Development of a professional network
• Succession planning so that graduates trained to fill the gaps in the workforce
• Cultural competency training is embedded in tertiary education (MCH courses)
• The ability to co-locate early childhood services
• There are optimum pathways for access to early years services
• Shift the criteria for funding based on LGA

Parent and Carer Forum Summary

Introduction

Karabena Consulting has recently undertaken a series of consultations as part of the development process for the VAEYHF. One of these key consultations was the Parent and Carer Forum held at the Barrbunin Beek Aboriginal Gathering Place. This report provides a summary of the feedback received from Aboriginal parents and carers about their experiences with early years health services.

What Currently Works in Aboriginal Early Years Health

Baggarrook Midwifery Care model. One parent expressed their deep appreciation for this model of care, exemplified by her sentiment that “they were amazing”. She spoke to the continuity of care, and the patient-centred approach that helped her feel supported.

Respectful Interactions. The act of health care professionals seeking permission during health checks, for both parents and children, was acknowledged as significant. Due to current or inherited trauma, all parents expressed dismay when health professionals engage in physical examination and contact without explicitly seeking consent.

Advocacy and Support. Presence of an Aboriginal advocate or an Aboriginal early years health worker was cited as beneficial in the health service delivery. Parents and carers expressed their desire to have access to advocates during appointments to help them feel more comfortable, supported, and culturally safe.

Approachability of Health Workers. Health workers who conduct health care in a relaxed demeanour and provide care in a welcoming manner were highlighted as effective in building trust and rapport with Aboriginal families. In particular, parents preferred when certain health information and screening was conducted during play groups in a supportive and relaxed atmosphere.

What Currently Doesn't Work in Aboriginal Early Years Health

Outdated Practices and Beliefs. There was a perception that older health professionals, at times, uphold ideologies that do not align with the realities of modern life. As a result, parents indicated that there's a noticeable contrast between these professionals and younger nurses who generally display greater acceptance of diverse life experiences. Where health professionals expressed traditional, conservative values about family or raising children, parents felt judged. Further, they often felt this judgement was due to their Aboriginality.

Inappropriate Comments. Some early years health workers have reportedly made comments that appear outdated and may inadvertently harm trust-building efforts. Ensuring that early years health professionals adopt strengths-based language will work towards alleviating this barrier.

Inconsistent Communication. Contradictory messages from various service providers, like Child Protection agencies and Hospitals, create confusion for parents. This becomes even more problematic when parents are already grappling with high levels of stress. Multiple parents explained that they had received contradicting information from multiple early years services, highlighting the need for increased coordination between services so there is consistency and clarity of communication.

Perceived Judgement. Experiences with judgemental health workers undermine the confidence and trust of Aboriginal families in the health system.

Recommendations from Parents and Carers for Improvement

Non-Judgmental Approach. A universal call was for health workers to adopt an approach that refrains from judging Aboriginal families, respecting their individual circumstances and choices. Many had felt that a variety of services encompassing the early years, such as health and education, made degrading assumptions about them due to their Aboriginality and perpetuated harmful stereotypes.

Culturally Safe Health Services. Parents and carers expressed a desire for an increase in the level of cultural safety and appropriateness in mainstream early years health services.

Advocacy during Appointments. Having an advocate attend health appointments was seen as a means to foster a supportive environment and assist families in understanding and navigating the health system.

Integration with Aboriginal Gathering Places. There's a strong preference to access early years health services at Aboriginal Gathering Places. The familiar and comfortable environment these places offer could enhance the effectiveness and appeal of health services. In particular, parents and carers highlighted the opportunity to integrate early years health into playgroups.

This forum illuminated some critical insights that can guide the evolution of the VAEYHF. Listening to the voices of Aboriginal parents and carers ensures that the framework will be both responsive and holistic. It is anticipated that by addressing these highlighted areas of strength and challenge, we can co-create a health system that genuinely serves and supports the well-being of Aboriginal children and their families.

Introduction

This report summarises and synthesises the insights from the workshop held at Narana Aboriginal Cultural Centre on November 2, 2023, hosted by Karabena Consulting with early years health professionals. In particular, it captures the compelling necessity for ‘Koorification’ and ‘decolonisation’ of Victorian early years health services delivered to Aboriginal families.

The stakeholders characterised current health care as overly ‘whitewashed’ and misaligned with the realities of the communities they serve. These robust discussions provided invaluable insights that influenced the development of a holistic VAEYHF, ensuring health service delivery that is culturally authentic, inclusive, and empowering for Aboriginal children and their families. (Note: unfortunately, no parents or carers were able to attend the afternoon forum.)

Findings

The Value of Outreach

A predominant theme of the workshop was the need to “meet parents where they are”. Delivering maternal and child health care in people's homes, with their permission and conducted by Aboriginal staff was a very powerful experience, particularly for young mums with multiple children under the age of 3. It was also a good way for teams from the one organisation to come together and ‘tag team’ providing a seamless service experience in the place where people felt safest.

Participants advocated for home visits and integration of health care into early childhood centres, playgroups and kindergarten services - specifically those that support enrolment of families and ensuring kindergartens were culturally safe. This would assist families who are currently experiencing significant cost of living pressures and housing issues.

Cultural Tailoring of Services (“Koorification”)

During the workshop, one participant stated that there's a tendency to “dump a white program into an Aboriginal space”.

This language clearly highlights the clunky and ineffective manner in which this is ‘implemented’ and the types of reporting required was robust, stringent and difficult to achieve because of the clinical focus, not all the cultural elements of programs could be appreciated or implemented. For example, all reporting and outcomes follow a mainstream, colonial program which posits Aboriginal people as vulnerable.

Also, whilst many people wanted access to cultural healing services, none were able to be provided within the constructs of the Indigenous Positive Parenting Program, nor were they accessible through mainstream services. Therefore, a subsequent and recurrent theme from the workshop was the need for health services to be culturally tailored or “Koorified.”

This term captures the imperative to weave Aboriginal ways of knowing, being, and doing, as well as cultural elements, seamlessly into the fabric of early years health services. For instance, key indicators of development, language, and approaches to health care need to be decolonised to ensure culturally responsive services.

Decolonisation of Health Frameworks

The present health frameworks were scrutinised for their heavy reliance on non-Indigenous methodologies and philosophies. A clear appetite was evident for a fundamental shift towards a decolonised model – one that is rooted in Aboriginal epistemologies and steered by Aboriginal leadership. Such a model would challenge and replace the existing Eurocentric frameworks and recalibrate them to centre Aboriginal voices and experiences.

There was not a strong reference to how this would be done, however; except to mention ASQ-TRAK training at the SNAICC conference was beneficial, that there was a need to grow the Aboriginal led health workforce by supporting them acquire skills that could address developmental delays in the community (i.e. hearing and sight testing).

Whilst workforce was referred to as essential, many new workforce participants are:

• new to the area of early childhood
• too young to witness what is happening for some of our families and are being triggered by the information and the experience
• had limited opportunity to develop skills in the area
• needed mentors and teams to work in - very hard to be an isolated practitioner
• did not value collaboration with mainstream services unless there was a Senior Aboriginal person in the organisation who was a manager of staff and could set the tone for interventions
• on unsustainable funding

Personal Narratives and Professional Insights

The professional contributions and personal stories shared at the workshop illuminated the diverse and often challenging experiences faced by families accessing early years health services. They indicated that many of the families they worked with, with reference to a few specific case studies, did not follow the expected schedule for antenatal and maternal child health appointments due to accessibility issues. They highlighted the need for flexibility in delivering early years health services for Aboriginal families so they are not necessarily judged against Western, colonial indicators of engagement.

The professionals spoke to this flexibility in one instance where there was a need to create a baby Aboriginal playgroup on a separate day to the toddler playgroup to create a culturally safe space that promotes belonging, for mothers, parents and carers at different stages of their children's development.

Prior to this, workers indicated that Aboriginal parents often felt marginalised and isolated in universal playgroups. These narratives reinforced the urgent need for services that not only respect cultural identities but also empower families through respectful engagement and service provision.

Workforce Gaps

There was constant reference to workforce pressures and gaps that inhibited the quality of care delivered to Aboriginal families. There was a call for more Aboriginal Health Workers, Aboriginal Midwives (only two in the state?), Aboriginal Maternal Child Health Nurses, etc. One participant, a Koorie Pre-School Enrolment and Cultural Safety Assistant, stressed the unrealistic demands of their job as they service 250 kindergartens in their region alone.

Client Journey Map Activity Summary

Group 1: Maximising the Potential of Current Service Delivery System

Preconception Care. Ensuring access to Aboriginal health services is of paramount importance for the success of preconception care. The availability of female GPs who have a strong connection to the community is essential in providing culturally sensitive care. It is crucial for young Aboriginal women to feel supported by their community and have the ability to connect with their heritage and identity.

Conception and Antenatal Period. During the conception and antenatal period, it is preferable to have female GPs within Aboriginal Community-Controlled Organisations (ACCOs) to provide the necessary support for expectant mothers. GPs should be well-versed in KMS programmes to offer informed choices between these and mainstream hospital care. The integration of Aboriginal liaison units within hospitals could significantly improve the support system for women attending appointments and enhance their overall experience.

“Having a female GP in an ACCO is ideal. GPs need to be educated around the KMS program so they can give women choice…”

“My youngest didn't know that even though she was far along in her pregnancy, she could have accessed the KMS team at any time…”

Postnatal Care. The postnatal phase should see an enhancement of the partnership between KMS programmes and hospitals, ensuring a seamless continuity of care. The ability of KMS to conduct postnatal visits is vital in building trust and support for Aboriginal mothers, which is integral to their health and well-being post-birth.

“Our aim is to accompany women to appointments in the hospital. If they're having to go to appointments we will have our team accompany women. It's often a very positive experience for the mother. We need flexibility in the KMS program to do this work. It isn't the hospital collaboration and partnership, its also having that professional relationship between the teams at KMS and the hospital. We're really blessed because midwives have worked across hospitals, MCH and in ACCOs. We get to do homebased postnatal visits. It's just a beautiful partnership and that builds trust for women because they know that you've got an idea of what the system is like and can really support our mothers well...”

Availability of Services. The limitations of the KMS programme only being available during weekdays needs to be addressed to provide round-the-clock support. Expanding the workforce is essential in managing the increasing demands and maintaining the quality of care provided to Aboriginal mothers.

“...So, unfortunately our KMS program is very Monday to Friday. Before I came there was historically a midwife doing, you know, basically seven days a week, 24 hours a day, support women in during birth doesn't matter what time day or night, but we have to did have a bit of a change in the process. And so now it's very much around that Monday to Friday support. So yes, the midwives will go and be a support person or the Aboriginal Health Worker will be a support person for our women which is just beautiful, but it does stop it doesn't stop right on five because someone's in labor. I'll get a call on there and can I still get started for another hour, but it's not being called up at midnight and going in it wouldn't be good though. The issue is around workforce and OHS management. I went through this because we wanted to deliver that type of service, but we just don't have a big enough team..”

Building Trust. Establishing a trustworthy presence in birth hospitals is critical in building confidence amongst Aboriginal women, who may find attending mainstream hospitals particularly challenging. Ensuring their inclusion in continuity of care networks and providing warm handoffs between KMS and Maternal and Child Health (MCH) services are crucial steps towards this goal.

“So the KMS's job is to support the woman in that period just to show them that its okay. Even though mainstream hospitals can be very triggering. We need a continuity of care network. So, being part of the KMS is to be included in those continuity of care network meetings. We've got one going so we can facilitate a warm handover between KMS and MCH. So in that antenatal period, ideally we would like to see MCH side by side in the health service but it's not the way it is…we need trust..?”

Addressing Structural Issues. Structural issues, such as different site practices, including vaping policies or organisational structure complications, need to be reviewed. A more integrated approach can help in addressing these challenges effectively.

Equipment and Support. Accessibility to nursery equipment programmes is essential to ensure that women and families are as prepared as possible. It is about providing the necessary support to facilitate a healthy and nurturing environment for the newborn.

Choice and Legislation. Flexibility in choosing child health providers should be provided, challenging the current legislative barriers that limit such choice. Enhancing cultural sensitivity in services and the registration process is also crucial for the development of a more inclusive health care system.

Cultural Knowledge and Framework Design. There is a need for a culturally appropriate Aboriginal MCH framework that recognises the specific needs of families. This should guide service selection and advocate for the appropriate funding required for enhanced programmes.

Funding. A flexible funding model that accounts for the unique requirements of programmes, such as family violence support and sleep settling services, must be established. This approach should replace the limitations imposed by block funding, allowing for more responsive and targeted resource allocation.

Service Delivery. Service delivery should be expanded to offer home visits to all families, not just those identified as vulnerable. This could potentially include first-time parents, providing them with much-needed support and guidance.

Capacity and Caseloads. It is vital to assess and define caseload capacities to ensure services are provided effectively without overstretching resources. Understanding the threshold of service provision is crucial for maintaining high-quality care.

Integration and Service Design. Service integration and design should be emphasised on the ground, ensuring that Aboriginal MCH services are not operating in isolation. This will promote a more cohesive approach to health care delivery for Aboriginal communities.

Partnerships and Information Sharing. Developing partnerships and inclusive processes for information sharing are key to ensuring efficiency and cultural sensitivity. Aboriginal health services should be prioritised in the communication chain, especially when handling sensitive family information, to provide the best care outcomes.

Group 2: A Non-Indigenous Mum with Mild Intellectual Disabilities, and Parent to Three Aboriginal Children

Background. Sally (not her real name), a non-Indigenous mother with three Aboriginal children, demonstrated considerable engagement with the local early years services and playgroups as part of the Wathaurong ACCO. Sally had positive interactions, particularly with the KMS nurse and Playgroup Coordinator, fostering a supportive environment for herself and her children.

Engagement with Services. Sally consistently attended MCH/KMS services and playgroup sessions, showing a high level of participation. She valued the cultural education her children received, ensuring they learned traditional dances and cultural practices, reflecting her commitment to their Aboriginal heritage. Despite living conditions that were sometimes suboptimal, Sally welcomed home visits from the health workers, indicating trust and openness to receiving support.

Challenges Encountered. Sally's children contracted head lice and scabies, common issues that can create barriers to continued engagement with community services. In addressing the issue, Sally was told she would not be able to bring her children to playgroup because of the high transmissibility of head lice and scabies in group settings. Sally could not cope with the treatment regime in a house that was subject to an environmental notification for hygiene and hoarding issues. She did not return to playgroup.

The family's housing situation was untenable, requiring a move to the other end of Geelong which added transportation challenges and contributed to disengagement with services. Economic and social isolation further compounded the difficulties faced by Sally, resulting in a notification to child protection services due to concerns about the children's wellbeing after she became disengaged from all services, except a doctor and a psychologist.

Support Provided. Health and educational professionals demonstrated flexibility, such as the psychologist meeting Sally in informal settings like coffee shops to encourage her engagement. Tailored support strategies were employed, such as direct home visits, provision of head lice treatment, and empathetic communication regarding health and safety concerns.

Offers of day care for her two younger children were not taken up as Sally, who has a mild Intellectual Disability, herself had a history of being in care and felt obliged to ‘parent all her children’. She also had major concerns that she would end up engaged with CP again.

Recommendations for Improvement.

• Stronger emphasis on maintaining cultural connections and community ties, to support both Sally's and her children's identities and resilience.
• Enhanced transportation support to ensure continued access to services despite relocation.
• Intensified home support to address hygiene and environmental health concerns, potentially preventing the escalation to child protection notifications.
• Further encouragement of early childhood education participation for Sally's children, highlighting the benefits for their development and wellbeing.

Conclusions. Sally's case underscores the importance of holistic and culturally sensitive approaches in the early years. It illustrates the need for targeted interventions that address the social determinants of health, such as housing, transport, and cultural connectedness, to improve outcomes for families. The challenge remains to bridge the gap between service provision and the complex, multifaceted needs of families experiencing intergenerational trauma and socioeconomic disadvantages. Building trust and sustaining engagement through respectful, consistent, and culturally informed practices are crucial to the success of early years initiatives within Aboriginal communities in Victoria.

Recommendations

1. Aboriginal-Informed Framework

The proposed Framework must be informed by Aboriginal knowledge systems and values, that is Aboriginal ways of knowing, being, and doing. This includes embracing traditional parenting and cultural practices that have been handed down through generations (e.g. Welcome Bubup to Country). This calls for a Framework that not only includes but is led by Aboriginal epistemologies, ensuring the services are truly reflective of the communities they aim to serve.

2. Cultural Customisation of Services

To achieve the “Koorification” of services, it is essential that health programs are developed with a deep understanding of Aboriginal cultural norms, values, and practices. This might entail redesigning service environments to be culturally welcoming, ensuring that staff are not only culturally competent but culturally connected, and that programs are delivered in ways that are congruent with cultural rhythms and life ways. Certainly, it calls for a reimagining of language used in the Framework itself (e.g. ‘elements’ as opposed to ‘pillars’) and the provision of health care.

3. Decolonising Existing Systems

A process to deconstruct current Eurocentric health models is necessary. This involves critically assessing how services are delivered, by whom, and the underlying assumptions about health and wellbeing that inform these services. The replacement of these models with a decolonised approach should be an ongoing process that is receptive to and directed by ongoing Aboriginal input and governance. Further, the Framework should be informed by ‘Aboriginal measures of success’ rather than simply colonial measures of success that can too often focus on, and emphasise the ‘gap’. In turn, this can elicit further feelings of guilt and shame amongst parents.

4. Community-Centric Engagement

The Framework's development must be intrinsically linked to community engagement, ensuring that the voices of Aboriginal parents, carers, and children in their respective communities are at the forefront. Co-design principles should guide the ongoing provision of services, ensuring they are flexible and responsive to the needs of families within different communities across Victoria.

5. Support Mechanisms for Professionals

Recognising the emotional and cultural labour that Aboriginal health professionals invest in their work, the framework should include clear support structures for these workers. This could involve peer support groups, supervision, and professional development opportunities focused on self-care, cultural care, and capacity building.

6. Ongoing Cultural Competence Training

It is imperative that non-Indigenous health professionals receive continuous, dynamic cultural competency training. This training should not be seen as a one-time requirement but as a lifelong professional journey, ensuring that service providers can maintain an effective, empathetic, and culturally sensitive practice.

7. Flexibility in Care

A common theme throughout the workshop was the need to meet parents where they are, both physically and emotionally. Delivering health care in a relaxed way (e.g. “it's more relaxed in their own lounge room”) enhances access and engagement and reduces levels of judgement. Change the focus of these home visits from only those with complex needs to all first-time parents - this will shift the deficit lens.

Further recommendations arising from the workshop include: establishing separate playgroups for infants and toddlers to cater to the different developmental needs and interaction styles of each age group; implementing a framework where healthcare workers lead practices, encouraging active engagement through culturally appropriate questions and discussions; reviewing and revising current early years programs to remove ‘whitewashing’ and ensure they are culturally relevant and respectful; providing targeted support and services for new parents and their babies, focusing on culturally informed care and education; offering structured playgroups that can be livestreamed to families at home, in partnership with Playgroup Victoria, ensuring digital inclusivity; encouraging the learning and use of Aboriginal languages and cultural practices, such as the Aboriginal Flag Song, within early years education; developing strategies to bridge the digital divide by ensuring families have access to necessary technology and the internet for educational and health resources; providing educational programs for parents that teach them about child development, health, and cultural identity, strengthening family units; designing the Framework with pillars that reflect and embed Aboriginal cultural identity and values, moving away from ‘whitewashed’ approaches; ensuring that flexibility is a core component of the VAEYHF to accommodate diverse needs, particularly in accessing pregnancy care services; ensuring GPs are informed about the option to refer patients to culturally informed midwifery services; defining the role and scope of Maternal and Child Health services, including the 10 key ages and stages, and ensuring they are delivered by accredited professionals; maintaining a comprehensive database of Aboriginal babies and children to monitor health outcomes and adjust services accordingly, while acknowledging recent changes in legislation and their impacts on the Child Youth and MCH network; ensuring there is a robust policy and protocol for sharing information within Drug and Alcohol services, respecting privacy while promoting holistic care; working closely with Best Start facilitators to align early childhood strategies with broader health objectives and community needs; adopting a holistic approach to supporting families, coordinating services across team leaders and family services, and prioritising internal engagement with families; and establishing regular internal engagement sessions with families, such as weekly meetings, to build trust and ensure service alignment with family needs.

These recommendations should be considered as part of an ongoing dialogue with Victorian Aboriginal communities to ensure the VAEYHF reflects their aspirations and meets their needs effectively. It's crucial that any implementation is done with continual consultation and feedback from the communities it intends to serve.

Next Steps

The workshop served as a platform to vocalise the critical demand for an empowering early years health Framework that breaks away from entrenched “whitewashed” practices. As Karabena Consulting progresses to integrate these findings into a preliminary Framework, the involvement and feedback from workshop participants remains invaluable. The goal is to refine a Framework that not only meets the health needs of Aboriginal families but does so in a way that uplifts their identity and aspirations.

Conclusion

In synthesising the discussions from the workshop convened at the Narana Aboriginal Cultural Centre, and the parallel forums with Aboriginal parents, we confront the unequivocal necessity for a culturally infused and responsive VAEYHF. The collective insights articulate a vision for a service delivery model that is holistically ‘Koorified’ – one that not only acknowledges but is intricately woven with the cultural threads of Aboriginal communities. This workshop emphasised the need for an earnest and collaborative reconfiguration of early years health services to break free from the prevailing ‘whitewashed’ paradigm and move towards a framework that is conceived in partnership with those it seeks to serve. Karabena Consulting, in alignment with the feedback from these engagements, is dedicated to steering this evolution, ensuring that the resultant Framework will be one that upholds the dignity, respects the diversity, and builds upon the resilience and strengths of Aboriginal children and families. It is with this commitment that we envisage a future where health services are not merely accessible but are inherently supportive and empowering for the communities they are designed to benefit.

Warrnambool Workshop and Forum (Gunditjmara Aboriginal Cooperative Ltd.)

Morwell Workshop and Forum

Bairnsdale Workshop and Forum

Introduction

This report draws on the dialogue held at Horsham, engaging with the experiences and suggestions of workers (Playgroup Coordinators, MCH, Goolum Goolum Family Workers, Early Educators) at Goolum Goolum for Aboriginal children. These insights are vital for informing the development of the VAEYHF, ensuring that it meets the nuanced needs of the community and is aligned with cultural values and practices.

Key Findings

Current Services and Insights.

• Horsham features positive initiatives such as dedicated Aboriginal Health Workers and a licensed GP for medical terminations, ensuring a range of health services are accessible to the community.
• Parents have expressed a need for early education regarding healthy pregnancies, highlighting the first 1000 days, including preconception, as crucial.
• The concept of ‘engagement through play’ emerged as a key strategy for imparting health education within safe and familiar community settings such as playgroups.

Gaps and Future Opportunities.

• There is a lack of proactive engagement strategies for educating potential parents before conception, especially within high schools, indicating a need for comprehensive sex education that includes the consequences of sexual activity and the spectrum of family planning options.
• A proposal for a local Co-Op endorsed media campaign suggests using social media platforms to disseminate factual health information to the community, thus leveraging the comfort and accessibility of digital spaces.

Antenatal and Birthing Experiences.

• The current pathway for confirming pregnancies and receiving antenatal care involves referrals outside the Aboriginal Medical Service, which could be streamlined.
• Discussions revealed a desire for Goolum Goolum to provide antenatal services directly, with a focus on a holistic model of care that encompasses the physical, emotional, and cultural needs of families.

Challenges with Current Systems.

• A significant issue raised pertains to the requirement for a confirmation of Aboriginality to access ongoing Maternal and Child Health services, which is not a state-wide mandate but is enforced by some services. This practice is seen as divisive and potentially re-traumatising, especially for members of the Stolen Generations.

Post-Birth and Early Childhood.

• Post-birth, families highlighted the value of home visits from health workers, emphasising the importance of establishing trust and providing holistic support.
• The role of family services in the early years, especially for families involved with Child Protection, was noted, with a call for flexibility and appropriateness in service provision.

Transition to School.

• Health checks and readiness for school activities, such as haircuts and the provision of school supplies, were positively viewed.
• However, concerns were raised about the rigidity of school expectations compared to the flexibility of early childhood settings, with a need for cultural safety in schools to be addressed.

Recommendations

1. Proactive Preconception Engagement: Develop programs to educate young people about healthy pregnancies and parenting before they become sexually active.
2. Digital Health Information Campaign: Utilise social media and digital platforms to provide accessible health information, endorsed by trusted local organisations.
3. In-House Antenatal Care: Upskill local health workers to provide antenatal care within Aboriginal health services, fostering continuity of care.
4. Cultural Safety in Health and Education: Ensure that both health services and schools are culturally safe environments, with staff trained in cultural competence.
5. Holistic Early Years Services: Advocate for the development of family-centred hubs, providing integrated services that are accessible, high quality, and culturally respectful.

Conclusion

The insights from workers at Horsham are integral to the refinement of health services for Aboriginal families. By listening to and addressing the concerns and suggestions of the community, the Department of Health can cultivate an Early Years Aboriginal Health Framework that is culturally attuned, proactive, and supportive of Aboriginal families from preconception through to early childhood and beyond.

Parent and Carer Forum

Introduction

This report synthesizes the diverse experiences and perspectives of parents of Aboriginal children in Horsham, Victoria. The insights gathered are intended to inform the development of the VAEYHF, ensuring it is reflective of the community's needs and culturally sensitive practices.

Key Findings

1. Cultural Practices and Healthcare Decisions: Parents value the integration of traditional Aboriginal practices in their children's lives. The 'Welcome Baby to Country' ceremony is highlighted as a significant cultural event, underscoring its importance in the community. Decision-making regarding healthcare, such as visiting doctors, is influenced by cultural beliefs and practices.
2. Healthcare Experiences and Challenges: Many parents shared personal healthcare experiences, especially around childbirth and postnatal care. The need for culturally sensitive care and support during these times was a recurring theme. Accessibility to healthcare services, particularly during the COVID-19 pandemic, posed significant challenges.
3. Financial Burdens and Resources: The high cost of healthcare and associated expenses (e.g., baby capsules, prams) is a significant concern for many families. There is a need for affordable and accessible healthcare options, especially for single parents and those without healthcare cards. Some community services, like car seat exchanges, have been beneficial, suggesting a need for more community-driven support initiatives.
4. Housing and Living Conditions: The struggle to secure private rentals due to racial bias and high costs is a major issue. This challenge extends to the affordability of housing and the difficulty in saving for homeownership. The community expressed a need for more support in securing stable and affordable housing.
5. Employment and Income: The report highlights the challenges in the job market, especially for young parents and those in lower-paid sectors like childcare. The need for better-paying jobs and more job opportunities in the region is evident.
6. Childcare and Early Education: Accessibility to childcare and the high cost of early education are major concerns. There is a call for more inclusive and culturally appropriate early childhood programs and services.
7. Community Support and Racism: The importance of a supportive community is emphasized, especially in terms of sharing information and experiences among parents. Concerns about racism and its impact on children and families were voiced, indicating a need for more education and awareness programs to combat racism.
8. Healthcare Accessibility: Many parents expressed the need for more accessible healthcare, including lactation consultants and support for new mothers. Issues around transportation to healthcare facilities and the challenges of managing appointments were discussed.

Recommendations

1. Integrate Cultural Practices: Incorporate Aboriginal cultural practices into healthcare and community services to ensure cultural sensitivity and relevance.
2. Improve Healthcare Access: Enhance the accessibility and affordability of healthcare services, especially for vulnerable groups like single parents and those without healthcare coverage.
3. Support Financial Challenges: Develop programs to assist with the financial burdens of healthcare and childcare expenses.
4. Address Housing Inequity: Implement initiatives to combat racial bias in housing and provide more affordable housing options.
5. Boost Employment Opportunities: Create more job opportunities, particularly for young parents, and improve wages in sectors like childcare.
6. Enhance Childcare Services: Expand access to affordable childcare and early education programs that are culturally inclusive.
7. Combat Racism: Implement education and awareness programs to address racism within the community.
8. Strengthen Community Support: Foster a supportive community network for sharing resources and information among parents.

Conclusion

The voices of parents in Horsham highlight the need for a holistic approach in the Victorian Early Years Aboriginal Health Framework. Addressing cultural, financial, and practical challenges is crucial in creating a supportive environment for Aboriginal children and their families. This report underscores the importance of community-driven solutions and culturally sensitive practices in healthcare and early childhood development.

Unfortunately, there were no participants in the Ballarat Workshop or Forum. There was one registration from an early years' health professional who was unable to attend the Bendigo sessions. They were offered an online consult instead to save on travel. This follow-up interview was conducted on the 22nd December 2023. Whilst much of the feedback reinforced the challenges and enablers in other workshops, some key insights from this interview were:

• The challenge of meeting the needs of Aboriginal children and families in the Bendigo region with a limited workforce and the lack of a KMS in the area.
• The importance of using culturally safe language and using materials and resources that embed Aboriginal language and culture.
• Using simplified language, and Aboriginal language and cultural imagery to overcome potential literacy barriers. The participant demonstrated one resource they use with parents that uses Aboriginal art and symbols to communicate key ideas.
• All parents of Aboriginal children should automatically qualify for Enhanced Maternal Child Health funding.
• Appointments under this model should serve as a one-stop-shop, with extended appointment times (1.5hrs) with holistic support that is person-centred.
• Need to offer parents support and connection in a relaxed way, such as a ‘park crawl’ where parents can meet for coffee and cake with an early years health person.
• There was a concern expressed that at certain ACCOs, parents must present a ‘Confirmation of Aboriginality’, which is not always possible and can cause distress and lead to further marginalisation.

Executive Summary

This report provides a focused analysis and set of recommendations for the Victorian Department of Health to inform the development of a VAEYHF. It emphasises the criticality of addressing cross-border issues affecting Aboriginal communities, particularly in the Echuca-Moama region, to ensure cohesive and equitable access to early childhood services.

Key Issues

1. Cross-Border Service Inconsistency: There is an inconsistency in early childhood services offered across the Victorian and New South Wales border. For instance, eye screenings are conducted at different stages, potentially leading to gaps in early detection of vision problems among Aboriginal children.
2. Education Access and Zoning Policies: Zoning policies in New South Wales pose barriers to access, with strict regulations affecting where children can attend school. This impacts the growth and service delivery in public schools in Moama due to population movement trends.
3. NDIS Accessibility: The National Disability Insurance Scheme's (NDIS) service reach in border areas like Moama is limited. Service variability between larger towns and smaller communities like Deniliquin affects children's access to consistent support.
4. Infrastructure and Housing Deficits: A lack of new housing and infrastructure development, particularly in regional areas, has a flow-on effect impacting early childhood services, such as kindergartens and schools.
5. Impact of COVID-19: The pandemic has uniquely affected border communities, influencing the delivery and access to early childhood education and healthcare services.

Key Recommendations

1. Harmonise Cross-Border Early Childhood Services: It is recommended that the Department of Health work in collaboration with New South Wales counterparts to harmonise early childhood health and education services, ensuring no child is disadvantaged due to cross-border discrepancies.
2. Review Zoning Laws: A critical review and potential revision of zoning laws in New South Wales could facilitate improved access to education for children living in border communities like Moama.
3. Expand NDIS Coverage: Efforts should be intensified to expand the reach of NDIS services in smaller towns and rural areas, thereby offering more consistent support across the border.
4. Stimulate Infrastructure Development: Collaborate with local governments to promote housing and infrastructure development in regional areas, thereby supporting the growth of essential early childhood services.
5. Leverage COVID-19 Learnings: Incorporate adaptive strategies based on the experiences of the COVID-19 pandemic to enhance the resilience of early childhood services.

The development of a VAEYHF should account for the unique challenges faced by border communities. Addressing cross-border issues with a collaborative and integrated approach will be crucial in ensuring that Aboriginal children in these areas receive consistent and equitable early childhood services.

Workshop Summary

Discontinuation of Early Intervention Programs

The cessation of the 'Cradle to Kinder' program represents a significant setback in preventive care for Aboriginal children. The program, which previously operated from birth to five years, provided a continuous support system that is now acutely missed in the community. There is a poignant sense of loss within the community, as the program not only offered early childhood support but also played a role in mitigating family violence by providing support and stability in the home environment.

Familial Disengagement and Community Impact

The withdrawal of such programs has precipitated a trend of disengagement among families, making it increasingly challenging to re-establish lost connections. This disengagement is not only distressing but also counterproductive to the aims of early childhood development strategies, which thrive on consistent and sustained community and familial involvement.

Volunteerism and Family Dynamics

The report highlights the delicate balance between community service and family obligations. Advocacy for volunteerism is strong, yet there is a prevailing belief that such commitments should not come at the expense of family time and witnessing one's own children's milestones and development.

Medication Shortages and Health Management

Recent medication shortages have underscored the need for robust healthcare strategies that accommodate the needs of children with specific conditions such as ADHD. The reliance on medication, coupled with the absence of paediatricians and the necessity for consistent medication compliance, has brought to light the vulnerabilities within our current healthcare system.

Investment in Early Childhood and the Pursuit of Data

There is a palpable concern regarding the focus on investment returns in early childhood spaces, particularly the potential overemphasis on data collection and assessment. This may lead to an environment more concerned with metrics than with the quality and appropriateness of child-centred development and learning.

Generational Differences and Workforce Dynamics

The report touches on intergenerational differences in attitudes towards work and resilience. There is a call to acknowledge the unique challenges faced by the new generation, who must navigate a vastly different employment landscape from that of their predecessors.

Empowerment and Gender Dynamics in the Workplace

A need to foster an environment of empowerment, particularly among women in the workforce, is identified. The report suggests that women in their thirties to forties may be pivotal in supporting and uplifting their peers, contrasting with the experiences of older generations who faced significant adversities in their career paths.

Recommendations

1. Re-establish and Invest in Preventive Programs: Reinstate programs like 'Cradle to Kinder' to provide continuous support for early childhood development and family stability.
2. Enhance Family Engagement Strategies: Develop initiatives to prevent familial disengagement and promote sustained participation in early childhood programs.
3. Support Volunteerism Without Sacrifice: Encourage community service but also advocate for policies that respect and accommodate family commitments.
4. Ensure Reliable Healthcare Provision: Address medication shortages and improve access to paediatric care, especially for chronic conditions.
5. Balance Investment with Child-Centric Approaches: While investments in early childhood are crucial, they should not solely chase data. Instead, focus on qualitative outcomes that reflect the well-being and development of children.
6. Cultivate Understanding Across Generations: Promote understanding between generations regarding the evolving demands of the workforce and the necessity for resilience.
7. Promote Women's Empowerment in the Workplace: Encourage a culture of empowerment for women, with emphasis on those who can bridge generational gaps and advocate for mutual support.

Further Considerations: Dental Health, Housing, and Cultural Preservation

This section of the report focuses on the VAEYHF, with an emphasis on dental health, housing challenges, and the preservation of cultural practices within early childhood frameworks. Acknowledging the unique challenges faced by cross-border communities, such as those along the Murray River, this report presents both issues and strategic recommendations for the Department of Health.

Key Issues Identified

Dental Health Concerns: Significant dental decay in Aboriginal children, exacerbated by dietary choices. Challenges in altering parental attitudes towards nutrition and food availability.

Housing Affordability and Quality: High rental costs in Aboriginal housing, placing a financial burden on families. Poor housing quality leading to safety hazards and health issues, such as black mould.

Cultural Language and Preservation: The need for language programs and cultural education within early childhood services. Limited engagement of child and maternal health nurses in early childhood centres.

Social Housing and Infrastructure: The scarcity of affordable social housing and the impact of the recent housing crisis. The need for regional support and infrastructure investment to facilitate community stability.

Recommendations

1. Enhance Dental Health Initiatives: Implement community-led dental health programs to improve nutrition and hygiene, and educate parents on the impact of diet on dental health and provide practical alternatives.
2. Address Housing Affordability: Advocate for increased social housing funding and support for Aboriginal families, and develop emergency housing solutions for families in crisis, including those fleeing domestic violence.
3. Invest in Cultural Education: Support the integration of Aboriginal languages and cultural practices in early childhood education, and strengthen partnerships with Aboriginal health workers to enhance cultural competence among early childhood staff.
4. Improve Housing Quality and Infrastructure: Prioritise the repair and maintenance of existing social housing to ensure safety and wellbeing, and encourage local government investment in infrastructure to support community needs, including early childhood services.
5. Collaborate for Regional Support: Foster collaboration between health services and regional councils to address cross-border challenges, and establish community hubs that co-locate kindergartens and maternal child health services to streamline support.

Conclusion

The VAEYHF must holistically address the compounded issues of health, housing, and cultural preservation to ensure the wellbeing and development of Aboriginal children. This report calls for a concerted effort from both the Department of Health and cross-sector partners to implement targeted interventions that respond to the complex needs of Aboriginal families, with a particular focus on those living in cross-border regions.

Further Considerations: Parental Anxiety and Disability Support

This report segment examines the developmental implications and service needs for Victorian Aboriginal children in the early years, particularly considering the effects of COVID-19 and the support for children with disabilities. It reflects on parental anxieties, the adequacy of the National Disability Insurance Scheme (NDIS), and the transition from medical to educational support, with an eye on enhancing the VAEYHF.

Key Issues

COVID-19 Impact on Parent-Child Separation: Heightened separation anxiety in parents who became caregivers during the pandemic, and concerns about potential negative perceptions in the child protection system due to parents' hesitation to place children in daycare.

Support for Children with Disabilities: Challenges faced by children with disabilities in mainstream schooling, and the need for specialized training among educators to provide inclusive yet tailored education.

NDIS Efficacy During Pandemic: Disparities in the effectiveness of the NDIS for families during COVID-19, and inefficiencies in utilising NDIS funds due to restrictions on face-to-face services.

Shift from Medical to Educational Support: Movement of service providers from healthcare settings to educational contexts, impacting the availability of therapeutic support, and a growing need for social workers within educational spaces to address complex family and developmental issues.

Recommendations

1. Enhance Parental Support Programs: Develop programs to address parental anxiety and support re-engagement with early childhood services post-pandemic, and provide resources to help parents understand the long-term benefits of early socialization for their children.
2. Strengthen Disability Support in Schools: Ensure that specialist schools and mainstream schools with inclusion programs are adequately resourced and staffed with trained professionals, and promote peer relationships and socialisation opportunities for children with disabilities, acknowledging their positive impacts.
3. Optimise NDIS Resources: Adapt NDIS plans to be more flexible and responsive to the changing circumstances brought on by the pandemic, and facilitate better access to support services, especially for families struggling to navigate the NDIS.
4. Expand Professional Development for Educators: Invest in professional development for educators to equip them with skills to support children with diverse needs, including behavioural management and communication strategies like PECS and visual aids.
5. Advocate for Allied Health in Schools: Encourage the retention of allied health professionals in educational settings to support children's developmental needs, and explore the introduction of school-based social workers to provide comprehensive support for students.

Conclusion

The report underscores the need for a multifaceted approach to address the developmental challenges faced by Victorian Aboriginal children, particularly those amplified by the COVID-19 pandemic. It highlights the importance of supporting parents, enhancing disability services in education, and ensuring that children have access to the necessary social and health services. Through strategic implementation of these recommendations, the VAEYHF can be significantly strengthened.

The Department of Health Shepparton Workshop, led by Kerry Arabena, focused on several crucial issues impacting families, especially in the context of floods and their aftermath.

Key Points Included

Environmental Hazards and Housing: Discussion about black mould in homes due to flood damage, highlighting the risk to children and families. This included concerns about the costs associated with mould removal and the lack of insurance coverage for many families.

Financial Strain: Many families were not insured and suffered significant losses due to floods. The meeting touched upon the rising costs of insurance and difficulties in securing affordable coverage, which compounded the financial strain on families.

Community and Mental Health Impacts: The floods had a substantial impact on community cohesion and mental health. There was a reported increase in emotional and psychological issues, particularly among mothers, which may be linked to the combined stress of COVID-19 and the floods.

Child Protection and Cultural Considerations: The meeting discussed the challenges in child protection, particularly in the context of Aboriginal families. This included the importance of considering cultural factors and the need for culturally sensitive approaches.

Healthcare Accessibility and Cultural Safety: The lack of culturally safe healthcare practices and the difficulty in accessing health services, especially for Aboriginal families, were highlighted.

Family Services and Support: The discussion covered the challenges in providing continuous support to families due to limited funding and high demand. The need for flexible service delivery and the limitations of current funding structures were discussed.

Child Care and Early Education: Concerns were raised about the potential for institutionalisation from a young age due to policies encouraging early childhood education and year 3 kindergarten.

Policy and Systemic Issues: The meeting underscored the need for a review of policies, particularly those related to child protection and healthcare, to ensure they are culturally sensitive and do not inadvertently discriminate against or harm Aboriginal families.

Throughout the meeting, the emphasis was on the need for more inclusive, culturally sensitive, and holistic approaches to address the diverse needs of families, especially those impacted by environmental disasters and systemic challenges.

Recommendations

• Revise Health Promotion Approach: Redefine health promotion materials to highlight positive aspects and achievements of Aboriginal communities, moving away from a deficit-focused approach.
• Develop a Holistic Healthcare Framework: Create a healthcare framework that equally values clinical, social, emotional, and cultural outcomes, ensuring a more holistic approach to health and wellbeing.
• Inclusive Language in Healthcare: Implement training for healthcare professionals to use more inclusive, empathetic language that avoids stigmatization and fosters trust.
• Review and Reform Unborn Child Protection Policies: Conduct a thorough review of unborn child protection policies, especially as they pertain to young mothers known to the department, to ensure they are sensitive and appropriate.
• Cultural Competence Training: Provide cultural competence training to healthcare workers to improve understanding and respect for Aboriginal cultures and practices.
• Enhance Community Engagement: Actively engage with Aboriginal communities to understand their needs and incorporate their feedback into healthcare practices and policy development.
• Improve Access to Basic Health Services: Ensure that universal health services like hearing and eye screenings are readily accessible, especially in cross-border areas and for Aboriginal communities.
• Enhance Cultural Safety in Healthcare: Train healthcare professionals in cultural competence to provide a safe and understanding environment for Aboriginal patients, particularly the youth.
• Bridge Support Network Gaps: Develop strategies to make both informal and formal support networks more accessible to Aboriginal communities.
• Reform Funding and Service Delivery: Rethink the current funding and service delivery models to focus more on the actual needs of the community rather than rigid KPIs.
• Preventive Approaches in Child Protection: Implement preventive measures in child protection that do not require families to reach a crisis point before receiving help, focusing on early intervention.
• Promote Coordination Between Services: Encourage increased coordination and continuity of care among different healthcare and social services to provide comprehensive support.
• Community-Based Decision Making: Involve Aboriginal communities in decision-making processes, particularly in developing models and strategies that affect them directly.

The workshop discussed the challenges Aboriginal families face in accessing the National Disability Insurance Scheme (NDIS) and the broader support system. It highlights the loss of traditional support networks, such as extended family, and the inadequacy of formal support structures. A key issue is the financial and logistical barriers to accessing NDIS, particularly the cost and availability of necessary assessments, which can be expensive and may require travel to distant locations like Melbourne. Additionally, there is a lack of timely support, with cases where immediate action is needed but delayed due to bureaucratic processes. The situation is further complicated by issues of vulnerability and the perception of Aboriginality in the system, suggesting a systemic bias that affects how support is provided.

Recommendations

• Increase Accessibility to NDIS Assessments: Make NDIS assessments more accessible and affordable, especially for Aboriginal families in remote or rural areas. Consider subsidizing assessment costs and providing more local assessment options.
• Strengthen Community Support Networks: Develop programs to rebuild and strengthen traditional community support systems, complementing formal support services.
• Improve Immediate Support Response: Implement measures within the NDIS and associated services to provide prompt responses to urgent cases, ensuring that families in immediate need receive timely support.
• Enhance Cultural Competence in Service Delivery: Train NDIS and child protection staff in cultural competence to better understand and address the unique needs of Aboriginal families.
• Reduce Bureaucratic Hurdles: Streamline the process for accessing NDIS and other support services, reducing bureaucratic hurdles that delay or prevent access to necessary support.
• Foster Collaboration Between Agencies: Encourage collaboration between the NDIS, child protection services, and Aboriginal community organisations to ensure a holistic and culturally sensitive approach.
• Challenge Systemic Bias: Address systemic biases within the support system that may lead to the marginalisation of Aboriginal families, ensuring equitable access to services.

Key Issues: The Floods

Environmental Impact and Health Risks: The discussion reveals serious concerns about environmental issues like black mould resulting from flooding, which poses significant health risks, particularly for young children who are close to the ground and more susceptible to these dangers.

Lack of Insurance and Financial Strain: Many Aboriginal families do not have insurance for their houses or contents, leading to devastating financial losses during floods. The cost of insurance has also risen dramatically, making it unaffordable for many.

Loss of Home and Identity: The floods have resulted in not just the loss of physical homes but also a sense of identity for many affected individuals, exacerbating the trauma.

Inadequate Emergency Response and Shelter: The emergency response to flooding, such as the provision of shelters, has been inadequate. Facilities like schools that could offer better accommodation remain closed, and existing arrangements do not adequately address the needs of vulnerable groups like women, children, and those with substance issues.

Recommendations for Action

• Support for Identity and Cultural Loss: Provide psychological and community support to individuals who have lost their homes and sense of identity, recognising that the impact of such losses goes beyond the physical.
• Enhance Emergency Response and Shelter Facilities: Improve emergency response strategies to provide adequate, safe, and culturally sensitive shelter options for displaced families during natural disasters. Utilize available resources like empty schools more effectively.
• Tailored Support for Vulnerable Populations: Ensure that emergency shelters and responses cater to the needs of vulnerable groups, including women, children, and individuals with substance issues, to provide safe and appropriate accommodation.
• Community Engagement in Disaster Response Planning: Involve Aboriginal communities in planning and decision-making for disaster response to ensure that their specific needs and cultural considerations are addressed.

Conclusion

The Workshop in Shepparton highlighted the unique experiences of the community in the region, especially grappling with the aftermath of the floods. This creates an intersection of needs for families that both encompasses and moves beyond early years health. Whilst not all the recommendations can be included as part of the VAEYHF, it is important to value the experiences and perspectives of the participant.

“What are the Aboriginal Early Years?”

Holistic Lifecycle Perspective: Aboriginal Early Years span the continuum from preconception through pregnancy, infancy, childhood, and up to school age. This perspective underscores the holistic nature of Aboriginal child development, recognising that it is an ongoing journey encompassing various life stages.

Aboriginal-Led Approach: Central to the concept is an Aboriginal-led framework that empowers Aboriginal communities to take charge of their children's upbringing and education, fostering a sense of ownership and cultural relevance.

Cultural Continuity: Aboriginal Early Years emphasise the importance of cultural continuity and safe spaces for families, promoting a positive experience during this crucial period. The concept prioritises the inclusion of Aboriginal languages and cultural elements in the education process.

Connection to Culture, Country, and Community: The central theme across responses is the significance of connecting children to their culture, community, Country, and family. This connection is seen as a foundation for building healing, health, and confidence.

Lifelong Learning and Holistic Wellbeing: The Aboriginal Early Years encompass every aspect of life-long learning, emphasising holistic health and wellbeing. This approach seeks to support pregnant mothers, families with infants, and parenting, fostering positive cultural moments.

Key Findings and Themes

Cultural Inclusivity: Aboriginal Early Years underscore the need for culturally safe care, including the presence of First Nations midwives and culturally relevant care throughout the pregnancy and postnatal period.

Community Involvement: The involvement of the community in welcoming new members, babies, into the fold is a recurring theme. The focus is on introducing children to their culture, keeping them safe, and nurturing a lifelong sense of belonging.

Aboriginal Philosophy and Epistemology: Aboriginal ways of living, philosophy, and epistemology are incorporated into the Early Years approach, highlighting the importance of Aboriginal knowledge systems.

Lifecycle Approach: The concept extends beyond infancy and childhood, recognising that teenage years are also integral to the Aboriginal Early Years. It involves the family, extended family, community, and all aspects of life-long learning, connection, relationships, health, and wellbeing.

Family-Centred Care: Family-centred care, with an emphasis on supporting mothers and partners, is pivotal during pregnancy and the first six years of a child's life. It nurtures the development of strong family bonds.

Conclusion

Aboriginal Early Years represent a holistic and culturally informed approach to child development, spanning from preconception to school age. This approach prioritises cultural continuity, connection to culture, community, and Country, and emphasises lifelong learning and holistic wellbeing. A central theme is the importance of an Aboriginal-led framework and community involvement, underscoring the significance of preserving Aboriginal culture and knowledge in nurturing future generations.

Enablers and Barriers

Enablers

1. Governance and Support: Elder governance plays a pivotal role, with noted advocacy and support from influential elders.
2. Culturally Suitable Workforce: Having Aboriginal staff, Aboriginal workers, First Nations midwives, maternal and child health nurses, and doctors enriches the healthcare landscape.
3. Culturally Appropriate Systems: Culturally safe organisations, resources, and continuity of care, coupled with community-controlled health services, facilitate better health outcomes.
4. Interdisciplinary Approaches: Integrated services that employ trauma-informed workforce, and support from community views, particularly from women, enhance the care continuum.
5. Cultural Wisdom: Recognition and inclusion of Aboriginal wisdom and knowledge passed down via Elders, family, and culture is an essential component.
6. Workforce Development: A focus on the next generation of workers ensures the longevity of culturally-informed services.
7. Facility Design: Culturally inviting and appealing facilities can create a more welcoming environment for Aboriginal communities.
8. Therapeutic Practices: Emphasising cultural therapeutic practices, trauma-informed practices, and collaborative methods avoid siloed approaches.
9. Communication: Birth notifications sent directly to ACCHOs streamline communication and enhance service delivery.

Barriers

1. Systemic Issues: Challenges like institutional racism, particularly in maternity services and the Department of Health, hinder the achievement of health objectives.
2. Cultural Sensitivity: A significant lack of cultural sensitivity, trauma knowledge, and understanding the impacts of colonisation persist.
3. Operational Challenges: Deficit-based language, risk-management approaches, reactive strategies instead of proactive prevention, and poor integration between mainstream and community services act as barriers.
4. Resource Limitations: Limited-service options, waiting lists, and inadequate protocols can deter families from engaging.
5. Financial Challenges: Inconsistent funding, poor salary packages in Aboriginal organisations, and inadequate output-based funding models affect service quality and employee retention.
6. Cultural Disconnect: A pressing barrier is the language barrier, with ILOs not speaking Aboriginal languages and the need to introduce Aboriginal languages in schools.
7. Fear of Engagement: Families often fear mainstream engagement due to perceived judgemental attitudes, affecting early detection of needs.
8. Service Accessibility: Travelling to specialist appointments, especially from rural areas, and limited allied health services in ACCHOs impede access.
9. Cultural Safety: Mainstream services can often be perceived as culturally unsafe, making community engagement challenging.
10. Training: Cultural awareness training is often reduced to a checkbox exercise in many mainstream agencies, instead of being genuinely embedded in practice.

In summary, while there are several enabling factors that promote Aboriginal health in early years, there exist systemic, operational, and resource-based barriers that need to be addressed to improve health outcomes and care continuity. Proper collaboration between the Aboriginal community, health services, and governmental agencies is crucial to bridge these gaps.

Current Client Journey Map

Based on the Padlet responses, here is a mapped-out client journey for an Aboriginal patient accessing healthcare from pre-conception through to their child starting school:

1. Pre-conception & Pregnancy

Experience with local ACCHO (Aboriginal Community Controlled Health Organisation) providing health services in the community. Women might see an Aboriginal Health Practitioner (AHP) or a midwife for an initial pregnancy test. Once pregnant, they are linked with KMS (Koori Maternity Services). Women then visit the GP for antenatal care. If previous experiences with mainstream healthcare have been negative or perceived as unsafe, some women may avoid services altogether. Women are referred to GP/obstetricians after 20 weeks of gestation.

There are few hospitals in Victoria offering culturally safe continuity of midwifery care; however, some models, such as the ‘Baggarrook model’, provide care from an Aboriginal midwife or a culturally trained midwife. This model offers a continuity of care throughout the pregnancy, labor, and postnatal period and has shown to reduce preterm birth significantly. The importance of early antenatal care, ideally before 12 weeks, is emphasized, with education and support provided at each appointment. Culturally safe screening, tailored approaches, and transportation needs are also addressed.

2. Birth & Early Postnatal

Birth support if required. Once the baby is born, families are engaged with AMCHI (Aboriginal Maternal and Child Health Initiative) until the child reaches 5 years of age. First home visit by the maternal and child health team, which can sometimes result in alerts on the family's file. Continuity of midwifery care continues post-birth, with the same midwife attending for up to 6 weeks during the postnatal period. ‘Welcome baby to country’ ceremonies and cultural practices.

3. Early Childhood

From 6 months onwards, parents might seek childcare and are linked with Aboriginal childcare. Children attend early start kindergarten, followed by 3 and 4-year-old kindergartens. Parents can access culturally safe support, which includes Koori Maternal and Child Health, playgroups, early interventions, parenting education, family support, etc.

Children with health concerns may need paediatric outpatient appointments at hospitals. This can be daunting, especially for families where English isn't the first language. Communication can sometimes be unclear, leading to confusion about subsequent steps or follow-up appointments. Collaboration with other services, like speech therapists, psychologists, occupational therapists, etc., is often required, though these may not always be readily available.

4. Pre-School to School Transition

Yearly health checks with AHP, MCHN (Maternal and Child Health Nurse), and GP. Possible child protection involvement in some cases. Enrolment in kindergartens or early learning centres, with a preference for MACS (Multifunctional Aboriginal Children's Services) when possible. Children know their ACCHO as a place where culture is celebrated, and they participate in cultural activities. They attend ECEC (Early Childhood Education and Care) services at their ACCHO and develop a strong cultural identity. Enrolling in primary school can sometimes face barriers like the requirement of birth certificates.

Throughout this journey, the overarching challenges include systemic racism, feeling culturally unsafe, and barriers to accessing services. The importance of culturally safe practices, community-driven initiatives, and understanding the unique needs and strengths of Aboriginal communities is emphasised.

Defining Aboriginal Early Years

The Aboriginal Early Years encompass a critical period in the lives of Aboriginal children and families. This period spans from antenatal care through to the early stages of a child's life, including infancy, toddlerhood, and the early years of primary education. During this time, various factors shape the health and wellbeing of both children and their families, and these factors are central to understanding the essence of Aboriginal Early Years.

Healthcare Services and Support

Antenatal Care: The Aboriginal Early Years begin with antenatal care, involving General Practitioners (GPs) and midwives, both from mainstream health services and Aboriginal Community-Controlled Organizations (ACCOs). This stage sets the foundation for a healthy start.

715 Health Screen: The 715 health screen plays a pivotal role in monitoring the health and development of Aboriginal children, ensuring that they receive the necessary healthcare interventions.

Maternal and Child Health Nurses (MCHN): MCHNs facilitate critical services, including birth notifications to local councils and administering immunizations, ensuring the health and safety of infants.

Daycare, Kindergarten, and Playgroup: Early childhood education and care settings provide a platform for comprehensive health support, including MCHN services, speech therapy, and allied health programs.

Family and Community Support

Parenting Programs: These programs offer guidance and support to parents, helping them navigate the complexities of early parenthood.

Cultural Connection: A strong desire to connect with one's cultural roots was a recurring theme, underlining the importance of cultural awareness and connection during the Aboriginal Early Years.

Community Engagement: Feeling disconnected from the community was expressed by some parents, highlighting the need for fostering community bonds during this crucial stage.

Cultural Resources: Incorporating cultural elements such as songs, books, and cultural resources into early years' development can help strengthen the connection to Aboriginal heritage.

Linking with Trusted Advice: Parents emphasized the significance of having access to reliable sources of advice and information during the early years of parenting.

Safe Environment: Providing a safe environment for children to play, explore, and learn is fundamental to their healthy development.

Family Planning and Contraception

Planning for conception and access to contraception emerged as important factors in Aboriginal Early Years health. Ensuring that individuals have the information and resources necessary to make informed choices about their family planning contributes to the overall wellbeing of the family unit.

Recommendations

Based on the feedback from this activity, it is paramount that future policies and programs in the domain of Aboriginal Early Years:

1. Integrate health services with cultural and community resources.
2. Emphasise the importance of safety at multiple levels - individual, family, and community.
3. Continually involve parents and carers in the decision-making process, recognising them as primary stakeholders.

Summary of Client Journey Maps on Butcher's Paper

Client Journey Map 1: Aboriginal Mother in Victoria with Connection to AOD Services, Pregnant with Second Child and Known to VACCA

Stage 1: Pregnancy. Mother does not seek regular antenatal care. She presents to the hospital for birth without prior antenatal appointments.

Stage 2: Birth & Immediate Postpartum. A trigger leads to the involvement of the Department of Families, Fairness and Housing (DFFH). An assigned social worker assists the mother. Possible engagement with an Aboriginal midwife for cultural support. AFLDM (Aboriginal Family Led Decision Making) is involved both at the hospital and later at VACCA.

Stage 3: Postpartum & Early Childhood. The baby is taken into care, which could be due to various reasons such as safety concerns or the mother's health. Several programs are activated to support the mother and her siblings, potentially involving counselling, parenting classes, and other welfare services. AFPRR (Aboriginal Family Preservation and Reunification Response) is likely initiated to promote family unity and provide additional resources and support.

Referrals: AOD Referral – the mother is referred to Alcohol and Other Drugs services due to her known connection. KCSSPS Referral – the mother receives a referral to the Koori Child and Support Services Program, which provides culturally appropriate services for Aboriginal families. GP involvement for overall health check and ongoing care. QEC VACCA – the Queen Elizabeth Centre's partnership with the Victorian Aboriginal Child Care Agency (VACCA) provides specialized programs and services to support Aboriginal families with children.

Overall, this journey map showcases the pathway an Aboriginal mother in Victoria, who has a connection to AOD services and is pregnant with a second child, might experience through maternal and early childhood health services in the state. Throughout this journey, multiple stakeholders are involved to ensure the well-being of both the mother and child, emphasizing culturally sensitive care and support.

Client Journey Map for an Aboriginal Mother in Victoria with a PV Bleed and Unknown Pregnancy

1. Emergency Situation. Mother visits the Emergency Department due to PV bleed. ER assesses the situation and identifies needed services. Referral is made to the EPC (Early Pregnancy Centre).

2. Initial Support and Assessment. Mother is referred to the Aboriginal Health Liaison Officer and a Social Worker. At the EPC, an assessment is conducted and tests are performed. Connections between antenatal services and social work are established.

3. Potential Medical Conditions. There's a possibility of an ectopic pregnancy, which involves consultation with a gynaecologist and family planning services.

4. Post-assessment Referrals. Mother is discharged and referred back to her GP. Social workers continue to provide support.

5. Health Evaluations and Referrals. Mother undergoes additional health referrals for testing and scanning, and is then referred to a birthing hospital. Collaborative care is provided by the MCH (Maternal and Child Health) service, GP, and a Specialist.

6. Choice of Maternal Services. Ideally, the mother can choose an Aboriginal service featuring an Aboriginal Midwife and Koorie Maternity Service which provides support for the first 6 weeks, or a regular mainstream service with a midwife. It's noted that mainstream services might not cater to cultural needs or provide a cultural lens.

7. Childbirth and Postnatal Care. Mother gives birth and receives support from the MCHN (Maternal and Child Health Nurse).

8. Ongoing Care and Cultural Integration. Mother continues her journey with the ACCHO (Aboriginal Community Controlled Health Organisation). She is integrated into services and cultural programs to ensure holistic care and cultural relevance.

Client Journey Map for an Aboriginal Young Mother in Victoria who has an Unexpected Pregnancy

1. Awareness & Education. Attend a Gathering Place or Cultural Youth Event. Receive information on preconception and sexual health. Understand the importance of consent and receive equitable sexual education. Learn about STIs and methods to prevent unexpected pregnancies.

2. Initial Health Check & Consultation. Go through the 715 Checks – a health assessment for Aboriginal peoples. Schedule a GP appointment; information provided about youth-friendly GPs. Discuss family planning options and learn ways to reduce associated stigma. Engage in yarning circles with elders and community for support and guidance.

3. Confirmation & Record Keeping. Update Medicare records, ensuring all maternal health information is recorded. Recognise the importance of a strong relationship and the values associated with a wanted pregnancy.

4. Support & Community Engagement. Join parenting groups specific for young mothers or culturally-tailored groups. Engage with elders and community members for advice, mentorship, and companionship.

5. Choice in Care Model. Explore different care models: KMS (Koorie Maternity Services), mainstream healthcare services, or a blend incorporating cultural practices.

6. Birthing Choices. Decide on the birthing method, considering traditional practices like 'birth on country' (birthing in one's ancestral lands or within their cultural community).

7. Post-Birth Celebration & Integration. Participate in the 'Welcome bubup to country' ceremony. Engage in a family and community celebration to introduce and celebrate the newborn.

Throughout this journey, it's imperative to ensure that the young mother feels supported, informed, and connected to both her cultural roots and the available healthcare services in Victoria.

A Decolonised Client Journey Map for Aboriginal Families from Pre-Conception to School

1. Pre-Conception. Integrate cultural yarning, where Aunties, Uncles, and community members share their stories, encapsulating diverse experiences. Restore cultural identity through lore, youth connections, relationships, and education. Proactive engagement – don't wait for community members to express their desire to conceive. Offer contraception discussions in a culturally sensitive manner. Ensure regular 715 health checks at Aboriginal Community Controlled Health Organisations (ACCHOs) and GPs.

2. Antenatal Care. Maintain and strengthen cultural connections throughout this phase. Offer 1-to-1 appointments during yarning sessions, providing an environment for deeper discussions and understanding. Include culturally appropriate antenatal and maternal child health (MCH) services. Engage fathers, siblings, and the extended family in antenatal services. Disseminate clear information on what to expect pre, during, and post birth. Offer support from compassionate, culturally-trained staff.

3. Birthing Experience. Provide the option for birthing on country. Offer birthing choices within both mainstream and cultural settings. Make storytelling from Elders available to guide families in designing their birthing plan. Ensure trauma-informed birthing suites and hospital visits. Offer robust support systems during and post traumatic birth experiences.

4. Post-natal Care. Emphasize cultural connection in postnatal services. Organise stigma-free circles focusing on young women and maternal experiences. Conduct yarning circles specifically for fathers. Provide avenues for lore restoration. Initiate the “welcome to bubup” ceremony to welcome the child. Centralise access to cultural information, promoting self-determination and informed choices. Encourage empowerment, building mothers' capacities through safe connections, relationships, and friendships. Foster culturally safe parenting groups.

5. Community and Kin Support. Forge a sense of belonging among mothers, fathers, and families. Connect fathers with peers, emphasising mutual learning and support. Offer support structures for kin. Actively involve fathers in appointments and classes, such as fathers' groups, to fortify their roles as nurturing family leaders.

Facilities and Service Structures. Create an Aboriginal early years hub encompassing a GP Clinic, Obstetrician, Koorie Maternity Service, and Pre & Post Birth Care. Prioritise longer appointment durations, ensuring ample time and care for each family. Engage Aboriginal Workers in Early Years positions, such as Midwives, Nurses, MCHNs, Kinder Teachers, and School Teachers. Focus on cultural overlays in mainstream services, bolstered by cultural training, ensuring self-determination, cultural safety, and continuity of care. Promote strength-based language and integrate lore frameworks. Actively incorporate fathers into the prenatal care journey.

This decolonised client journey map emphasizes the importance of cultural connection, community support, and comprehensive healthcare, ensuring a holistic and culturally-safe experience for Aboriginal families in Victoria.

The following client journey maps were developed by participants, and respond to different scenarios. They are not all uniform in structure, yet reflect the method applied by each group.

Client Journey Map for an Aboriginal Mother Who Experiences a Miscarriage

1. Pre-Pregnancy Complication Awareness. Mother suspects or knows about her pregnancy. Action: books an appointment to see a General Practitioner (GP) or Koorie Maternity Services (KMS).

2. Initial Consultation. Mother meets GP or KMS. Decision point: depending on the stage of pregnancy (early, late, very late), the nature of care is determined.

3. Hospital Choice & Antenatal Visits. Mother decides on a preferred hospital. Action: undertakes antenatal visits at Victorian Aboriginal Health Service (VAHS) and the chosen hospital.

4. Shared Care. The care of the mother is shared between the hospital of choice, the midwives at VAHS, and the GP.

5. Pregnancy Complications & Referral. If complications are identified during pregnancy: the mother meets the midwife and Aboriginal Health Worker (AHW) or GP. The mother is referred to the hospital with the support of the AHW. Transport and other support mechanisms are arranged for the mother's hospital visit.

6. Miscarriage Confirmation & Support. If a miscarriage occurs, the hospital or doctor confirms the miscarriage. Immediate support is provided to the mother. This includes counseling sessions, reassurances that the miscarriage was not her fault, and connecting her with support groups where she can share her experiences with other mothers who have gone through similar experiences.

7. Remembering & Healing. As a tribute and a way of remembering the unborn child, mothers are given the option to plant a tree or bury seeds as a symbolic gesture of life and memory.

8. Regular Check-Ins. Regular check-ins with the mother ensure her emotional and physical wellbeing. Continued support, counseling, and community engagements are encouraged.

Client Journey Map for an Aboriginal Mother Who Has a PV Bleed as a Result of Family Violence

System Level Steps

1. Emergency Presentation. Mother arrives at Austin Hospital's Emergency Department (ED) at 22 weeks pregnant with a PV bleed. The bleed is identified as a result of family violence.

2. Child Protection & Referral. Child protection services are immediately alerted. Mother is transferred to Mercy Hospital. An Aboriginal Liaison Officer (ALO) is contacted for support.

3. Medical and Social Assessment. If the mother discloses the family violence, the hospital will notify a social worker. Medical tests and examinations are conducted to ascertain the health of the mother and unborn child.

4. Social Worker Intervention. The social worker evaluates the mother's needs, safety, and future care plans.

Family Experience Steps

1. Trust & Truth. The mother grapples with the decision to trust the hospital staff enough to disclose the truth about her experience with family violence. Compounding her stress is the presence of another child and concerns regarding child protection intervention.

2. Explaining & Reliving Trauma. The mother has to recount her traumatic experiences to new professionals. The availability of the ALO may be inconsistent, especially outside of working hours. Questions arise concerning the safety and whereabouts of her other child.

3. Communication & Understanding. The mother's comprehension of the hospital's communication becomes crucial. Her ability to advocate for herself and her children is diminished due to the trauma and fear. In an unfriendly or unfamiliar environment, she may freeze or shut down.

Insights

The journey reveals a stark contrast between the methodical steps of the system and the emotional turbulence experienced by the mother. While the system acts procedurally, the mother's reality is filled with anxiety, mistrust, fear, and trauma. The mother's traumatic experience of being physically harmed, combined with the shock of an unknown pregnancy and the fear for her child's safety, can lead to a heightened state of stress and potential emotional paralysis. Cultural and patient-sensitive care is essential, and the potential lack of available ALO support can exacerbate feelings of isolation and mistrust. The journey underscores the need for trauma-informed care, cultural sensitivity, and strong inter-hospital communication to ensure the mother doesn't have to repeatedly relive her trauma.

Recommendations

1. Enhanced Inter-hospital Communication: Ensure seamless communication between Austin Hospital and Mercy Hospital to prevent the mother from having to retell her traumatic story multiple times.
2. Immediate Trauma-Informed Care: Once family violence is identified or suspected, immediately provide trauma-informed care to help the mother navigate her emotions and choices.
3. Cultural Sensitivity Training: Equip hospital staff with cultural sensitivity training to better understand and assist Aboriginal patients.
4. Guaranteed ALO Support: Work towards a 24/7 ALO availability system to ensure Aboriginal patients always have access to this crucial support. If not available in person, consider virtual consultations or phone support.

Client Journey Map: Aboriginal First-Time Mother, Planned Pregnancy

1. Pre-conception. Community connection – establish a strong connection within the community, including establishing contacts and support groups that will assist throughout the journey. Primary health care – assistance with finding GPs and understanding the importance of preconception health.

2. Pregnancy. Notification: antenatal notification about pregnancy and due date. Engagement: meeting with parents before birth to build a trusting relationship, explain what to expect, engage in deep listening, and understand parents' wishes and preferences. Connection with Aboriginal Engagement Worker to build a community connection.

3. Post-birth. Birth notice: MCH receives birth notice through the Council. Outreach: MCH contacts family to inform about various program choices available (VAHS, DBDF, UMCH, etc.), the culturally welcoming and safe spaces provided, and opportunities to interact with trained staff. Cultural connections: offer parents first-time parent/carer groups; integration of cultural practices, e.g., Acknowledgement of Country, Welcome Bubup to Country; yarning circles for shared experiences and community bonding. Community playgroups: encourage attendance at local, supportive Aboriginal playgroups. Baby café: a space where mums can drop in, interact with experienced women, get a cup of tea, and rest. Health services: provide information on accessing allied health services, both private and community-based. Child care: assistance in finding childcare solutions that are culturally sensitive and supportive. Early Start Kindergarten: facilitate enrollment in early start kindergartens, e.g., Bubup Wilam.

4. Growing Years. Continued health support: ongoing support to find and connect with GPs and other health professionals. Education: ensure the child is linked to supportive educational programs, especially ones that understand and respect their cultural heritage. Supportive communities: encourage continued participation in yarning circles and community playgroups. NDIS support: if needed, guidance on navigating NDIS and ensuring the child gets the support they require.

5. Transition to School. Preparation: provide resources and guidance for the child's transition to school. Continued community engagement: ensure the family remains connected to supportive community groups and resources.

Personal Touchpoints

Photo Connection: Having a photo of the primary contact person (like Kristen) in all offices to provide a familiar face for the families.

Personalised Outreach: When families don't respond to traditional outreach, have dedicated staff (like Sharon) personally reach out, even visiting families if necessary.

Staff Availability: Make staff available in waiting rooms or other common areas for casual, informal discussions, making families feel more comfortable.

Notes

• The journey is not linear; families might move back and forth between stages depending on their needs and circumstances.
• The emphasis is on cultural sensitivity, community connection, and flexibility to cater to the unique needs of each family.
• Personal touchpoints like photo connections and direct outreach make the journey more personal and supportive for families.