NACCHO Aboriginal Health #NACCHOagm2018 Report 1 of 5 : NACCHO welcomes the launch by @KenWyattMP of the first @AIHW report solely focusing on the health and wellbeing of young Indigenous people aged 10–24

 ” As the oldest continuous culture on Earth, we know that maintaining our connection to country and our cultural traditions is a key to our health and wellbeing.

The report also raises some of the challenges faced by young First Australians including 42 per cent who were not engaged in education, employment or training.

Although there has been a decline in smoking rates for young First Australians, one in three people aged between 15–24 was still a daily smoker in 2014-15 and 62 per cent of those aged 10-24 had longer-term health challenges such as respiratory or vision problems or mental health conditions.

Clearly there is much work to do to strengthen prevention and early intervention initiatives that will help build strong families and communities.’

Minister Ken Wyatt Press Release See Part 3 Below : Noting we will publish the Ministers full launch speech later this week 

We thank both the Minister and the AIHW for choosing our sell out NACCHO Members’ Conference attended by over 500 members and stakeholders to launch the first AIHW report that solely focuses on the health and wellbeing of our young Indigenous people aged 10–24.

By providing insights into their health and wellbeing including areas where they are doing well and challenges they face, the report aims to contribute to better outcomes for Indigenous young people today, as they move into adulthood, and for future generations of Indigenous Australians.”

Mr John Singer, Chairperson and Donnella Mills Deputy Chair of the National Aboriginal Community Controlled Health Organisation last week welcomed the launching by Minister for Indigenous Ken Wyatt at NACCHO Members’ Conference and AGM , the Australian Institute of Health and Welfare’s (AIHW’s) report Aboriginal and Torres Strait Islander Adolescent and Youth Health and Wellbeing 2018

Introduction

  1. Young Indigenous population
  2. Wellbeing of young Indigenous people
  3. Health of young Indigenous people
  4. Social and economic determinants
  5. Health risk factors
  6. Health services
  7. How do young Indigenous people compare

Download Copy of Report 

aihw-ihw-198

 ” NACCHO Youth Health Conference – future ACCHO “ leaders of tomorrow “

 ” Last Tuesday I welcomed seventy-five young people from around Australia to our inaugural NACCHO Youth Health Conference: Future leaders of Tomorrow where they discussed their health and public policy issues affecting our youth. I was inspired by these future ACCHO “ leaders of tomorrow “ with their positive and innovative report back to the plenary session”

John Singer NACCHO Chair: Noting a full NACCHO Youth report will be published later this week 

Mr Singer observed that this snapshot-style report has been designed to provide an easy overview of the key issues, suitable for a wide audience including his 145 NACCHO members operating 302 urban, regional and remote ACCHO plus other policymakers, researchers and service providers.

Youth is a key transition period in a person’s life. It is a time when decisions are made about relationships, education and career paths, employment and finances. The social, economic, environmental and technological changes that have occurred in recent decades mean that young people now face issues that previous generations may not have experienced.

Young Aboriginal and Torres Strait Islander people may face additional obstacles in making a successful transition to adulthood. The effect of inter-generational trauma, racism and prejudice, and socioeconomic disadvantage are all relevant in understanding the experiences of young Indigenous people today

The report provides data on 65 indicators. The indicators are grouped according to their focus on health and wellbeing outcomes, social determinants and risk factors or the use of health services.

The report brings together data from a variety of sources, and includes information on health outcomes, determinants and service use for Indigenous youth with data disaggregated by age group, sex, state and territory and remoteness areas.

Part 2 Key findings:

  • In 2016, there were around 242,000 Indigenous people aged 10–24 in Australia. About 1 in 20 young people in Australia was Indigenous.
  • In 2014–15, a majority of young Indigenous people aged 10–24 assessed their health as either ‘excellent’ or ‘very good’ (63%).
  • 61% of young Indigenous people aged 10 to 24 recognised their traditional homelands or traditional country, and 69% were involved in cultural events in the previous 12 months.
  • There was an increase in the proportion of young Indigenous people aged 20–24 who had Year 12 or equivalent attainment from 47% in 2006 to 65% in 2016.
  • Young Indigenous people aged 15–24 who smoked daily declined from 45% in 2002 to 31% in 2014–15. There was also an increase in young people who never smoked from 44% in 2002 to 56% in 2014–15.
  • The mortality rate for young Indigenous people has declined, from 70 per 100,000 in 2005 to 67 per 100,000 in 2015. There were an estimated 490 avoidable deaths for young Indigenous people aged 15–24, representing 83% of Indigenous deaths for this age group.
  • In 2012–13, most young Indigenous people aged 10–24 had access to a GP in their local area (83%).
  • Between 2010 and 2016, the proportion of young people aged 15–24 who had an Indigenous health check (MBS item 715) rose from 6% to 22%.

There remains key challenges to be addressed:

  • In 2016, 42% of young Indigenous people were not engaged in education, employment or training.
  • Although there has been a decline in smoking rates for young Indigenous people, 1 in 3 Indigenous youth aged 15–24 were still daily smokers in 2014–15.
  • 62% of young Indigenous people aged 10–24 had a long-term condition, most prevalent was respiratory disease (36%) and eye and vision problems (20%) and mental health conditions (10%).
  • In 2011, the leading contributors to the disease burden for Indigenous 10 to 24-year-olds were suicide and self-inflicted injuries (13%), anxiety disorders (8%), alcohol use disorders (7%) and road traffic accidents (6%).
  • In 2015-16, the leading causes of hospitalisations for young Indigenous people aged 10–24 were injury and poisoning (37 per 1,000) and mental and behavioural disorders (20 per 1,000).

Part 3 Minister Ken Wyatt Press Release

The health and wellbeing of First Australian teenagers and young adults is the focus of a unique new report released today.

The Aboriginal and Torres Strait Islander Adolescent and Youth Health and Wellbeing 2018 report reveals specific, national data on 10-24 year olds for the first time.

The positive outcomes highlighted in this Australian Institute of Health and Welfare (AIHW) research show where concerted and targeted efforts by First Nations families, communities, government and health care organisations are getting results.

Sixty-three per cent of First Australians aged 10–24 assessed their health as either ‘excellent’ or ‘very good’.

The number of First Australians aged 15-24 who smoked daily declined from 45 per cent in 2002 to 31 per cent in 2014-15. There was also an increase in young people who never smoked, up from 44 per cent in 2002 to 56 per cent in 2014 15.

In 2012-13, 83 per cent of Aboriginal and Torres Strait Islander people aged 10-24 had access to a GP in their local area.

Between 2010 and 2016, the proportion of young people aged 15–24 who had an Indigenous health check (MBS item 715) almost quadrupled, from 6 per cent to 22 per cent.

It is also pleasing to see 61 per cent of our young people reported having a connection to country and 69 per cent were involved in cultural events in the previous 12 months.

As the oldest continuous culture on Earth, we know that maintaining our connection to country and our cultural traditions is a key to our health and wellbeing.

The report also raises some of the challenges faced by young First Australians including 42 per cent who were not engaged in education, employment or training.

Although there has been a decline in smoking rates for young First Australians, one in three people aged between15–24 was still a daily smoker in 2014-15 and 62 per cent of those aged 10-24 had longer-term health challenges such as respiratory or vision problems or mental health conditions.

Clearly there is much work to do to strengthen prevention and early intervention initiatives that will help build strong families and communities.

While the health of babies and younger children creates a crucial foundation for healthier and longer lives, data like this is vital in ensuring a good start continues into adulthood.

It will inform the Closing the Gap refresh and help us to understand what is working well and where we need to focus our energies, so all young First Australians can reap the benefits of better health and wellbeing.

Our Government has committed to spending approximately $10 billion to improve First People’s health over the next decade.

I thank the AIHW and Professor Sandra Eades, Chair of the AIHW Expert Advisory Group and the team of experts for their work on this important and timely report.

Aboriginal and Torres Strait Islander Adolescent and Youth Health and Wellbeing 2018 can be found on the AIHW website.

 

NACCHO Aboriginal Health and #Nutrition : Download @HealthInfoNet review that confirms community involvement is the most important factor determining the success of Aboriginal food and nutrition programs

It is important to note that from all the available evidence reviewed, that the most important factor determining the success of Aboriginal and Torres Strait Islander food and nutrition programs is community involvement in the program initiation, development and implementation, with community members working in partnership across all stages of development’.

HealthInfoNet Director, Professor Neil Drew

The Australian Indigenous HealthInfoNet (HealthInfoNet) at Edith Cowan University has published a new Review of programs and services to improve Aboriginal and Torres Strait Islander nutrition and food security.

Download

Review+of+programs+and+services+to+improve+Aboriginal+and+Torres+Strait+Islander+nutrition+and+food+security

This review is a companion document to the recent Review of nutrition among Aboriginal and Torres Strait Islander people published in February 2018. It builds on the broad discussion in that review by capturing a wider sample of evaluated programs and services and providing more detail about successful programs.

Written by Amanda Lee from the Australian Prevention Partnership Centre, The Sax Institute and Kathy Ride from the HealthInfoNet, the review highlights that improving diets, food supply and food security to better prevent and manage poor nutrition and diet-related disease is vital to the current and future health of Aboriginal and Torres Strait Islander people.

This review identifies that many Aboriginal and Torres Strait Islander communities are motivated to tackle diet-related health issues and they recognise the importance of improving nutrition to prevent and manage growth faltering and chronic disease. However, community effort needs to be supported through the building of an Aboriginal and Torres Strait Islander nutrition workforce, and adequate government investment of funds and policy commitment to sustain improvement of nutrition and diet-related health.

Improving diets, food supply and food security to better prevent and manage poor nutrition and diet-related disease is vital to the current and future health of Aboriginal and Torres Strait Islander
people.

Effective action requires a whole-of-life approach, across the whole health continuum, including: preventive community interventions; public health nutrition policy actions; nutrition promotion; and quality clinical nutrition and dietetic services .

Previous reviews of Aboriginal and Torres Strait Islander food and nutrition programs have consistently noted the lack of availability of rigorously-evaluated interventions, especially with respect to long term evaluations .

Quality evaluations with practical recommendations are critical to helping the workforce build on what has been learnt. Evaluation reports and recommendations need to be publically available for policy makers and practitioners to learn from, apply and build on .

Other reviews have found that most nutrition interventions have focused on remote settings despite most Aboriginal and Torres Strait islander people living in urban and regional areas.

Most of these employed a comprehensive, whole-of-population approach – combining provision and promotion of healthier options in community food stores with nutrition education – which was found to be effective .

As with all health programs, nutrition programs should be developed with the target communities, be delivered according to cultural protocols, be tailored to community needs, and not be forced, or perceived to be forced, upon communities (see Box 1)

A major success factor is community involvement in (and, ideally, control of) decisions relating to all stages of program initiation, development, implementation and evaluation [9; 10; 14]. Program implementation methods that build confidence among collaborating Aboriginal and Torres Strait Islander and non-Indigenous health agencies are fundamental to building capacity to enhance Aboriginal and Torres Strait Islander nutrition and health .

The typical short-term funding cycles experienced in this area are at odds with the time required for community stakeholders to develop capacity to mobilise and build momentum for specific interventions.

An effective ecological approach to chronic disease prevention also requires inter-organisational collaboration in planning and implementation . While many programs targeting nutritional issues are implemented as healthy lifestyle programs to address obesity, it must be remembered
that diet is more than a ‘lifestyle’ choice – it is determined by the availability of and access to healthy food, and by having the infrastructure, knowledge and skills to prepare healthy food.

To improve diet-related health sustainably it will be necessary to take a food systems approach .

The underlying factors influencing nutrition and food security in Aboriginal and Torres Strait Islander communities include socioeconomic factors such as income and employment opportunities, housing, over-crowding, transport, food costs, cultural food values, education, food and nutrition literacy, knowledge, skills and community strengths.

Key points

• Nutrition, public health and Indigenous health experts are calling for a nationwide, comprehensive, sustained effort to address Aboriginal and Torres Strait Islander nutrition.

Primary prevention of diet-related disease and conditions

• The most effective community-based programs tend to adopt a multi-strategy approach, addressing both food supply (availability, affordability, accessibility and acceptability of foods), and demand for healthy foods.
• Supply of micronutrient supplements rather than food does not address the underlying issues of food insecurity, poor dietary patterns or high rates of obesity.
• The population health intervention of folate fortification of bread flour has had the desired effect of increasing folate status in the Australian Aboriginal population.
• Analysis of remote store sales data during the Northern Territory Emergency Response found that income management provided no beneficial impact in relation to purchasing of tobacco, soft drink or fruit and vegetables.
• Nutrition programs implemented at the community level mainly focus on improving food supply and/or increasing demand for healthy food.
• As with all health programs, all nutrition programs should be developed with communities, be delivered according to cultural protocols, be tailored to community needs, and be directed by the communities.

Primary health care and clinical nutrition and dietetic services

• Primary health care services for Aboriginal and Torres Strait Islander people need to deliver both competent and culturally appropriate dietetic and chronic disease care.
• Health services run by Aboriginal and Torres Strait Islander communities provide holistic care that is relevant to the local community and addresses the physical, social, spiritual and emotional health of the clients.
• The involvement of Aboriginal and Torres Strait Islander Health Workers has been identified by health professionals and patients as an important factor in the delivery of effective clinical care to Aboriginal and Torres Strait Islander people, including in dietetics and
nutrition education.

Aboriginal and Torres Strait Islander nutrition workforce

• A trained, well-supported and resourced Aboriginal and Torres Strait Islander nutrition workforce is essential to deliver effective interventions.
• It is estimated that less than 20 Aboriginal and Torres Strait Islander people have ever trained as nutritionists and/or dietitians in Australian universities.

NACCHO Example from Nhulundu Health Service

******************** W I N ********************
A $100 GROCERY VOUCHER & TUCKA-TIME GIFT PACK

To enter simply like our page, comment a photo showing us your healthy meal and share! 🍉🍊🍓🥦🥑

Giveaway closes 5pm Friday 16/10/18. Winners will be announced on 18/10/18. You can enter as many times as you wish, good luck to everyone!

Get healthy, get cooking and get snapping

 

NACCHO Aboriginal Health and #Sugarydrinks : @BakerResearchAu Study reveals the damaging effects for inactive, young, obese people who consume soft drink regularly : What’s going on inside your veins ?

“ With lifestyle-related diseases such as obesity rising rapidly and sugar sweetened beverages the largest source of added sugars in Western diets, understanding the ‘real world’ health impact is critical in determining ‘real world’ prevention and intervention strategies,”

Professor Bronwyn Kingwell, the study’s senior author : See Baker Institute Press Release Part 1

If you did this day in, day out, your pancreas would be under considerable stress – and this is how diabetes can develop.

Having a little can of soft drink in the morning is going to have lasting effects throughout the day.”

If your diet has too much sugar in it, forcing your body to keep your insulin high all the time, eventually your cells will grow insulin-resistant. That forces the pancreas to make even more insulin, adding to its workload. Eventually, it will burn out

Professor Bronwyn Kingwell. See SMH Article Part 2 What’s going on inside your veins after you drink a soft drink

See NACCHO Nutrition ,Obesity , Sugar Tax,, Health Promotion 200 + articles published over 6 years and see our policy below

 ” The 2012-13 Health Survey identified that Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians, with the prevalence increasing more rapidly in Aboriginal school-aged children.

Overweight and obesity in childhood are important predictors of adult adiposity, increasing the risk of developing a range of medical conditions, each of which is a major cause of morbidity, mortality and health expenditure.

While it is surprisingly clear what needs to be done to improve the health of Indigenous children, recent cuts to Indigenous preventative workforce and nutrition programs throughout Australia have severely reduced the capacity to respond.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care.

The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve. “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

Press Release : Study reveals the damaging metabolic effects for inactive, young, obese people who consume soft drink regularly

We know drinking soft drink is bad for the waistline, now a study by Baker Heart and Diabetes Institute researchers provides evidence of the damaging metabolic effects on overweight and obese people who regularly consume soft drink and sit for long periods.

Researchers have quantified the detrimental effects on glucose and lipid metabolism by studying young, obese adults in a ‘real-world’ setting where up to 750ml of soft drink is consumed between meals daily and where prolonged sitting with no activity is the norm.

The results, outlined by PhD candidate Pia Varsamis in the Clinical Nutrition journal, show how habitual soft drink consumption and large periods of sedentary behaviour may set these young adults on the path to serious cardiometabolic diseases such as fatty liver disease, type 2 diabetes and heart disease.

Whilst most studies to date have focused on the relationship between soft drink consumption and obesity, the large amount of added sugars contained in these drinks has additional implications beyond weight control.

Watch TV Interview

Senior author, Professor Bronwyn Kingwell, who heads up the Institute’s Metabolic and Vascular Physiology laboratory, says the acute metabolic effects of soft drink consumption and prolonged sitting identified in this latest study are cause for concern.

“With lifestyle-related diseases such as obesity rising rapidly and sugar sweetened beverages the largest source of added sugars in Western diets, understanding the ‘real world’ health impact is critical in determining ‘real world’ prevention and intervention strategies,” Professor Kingwell says.

She says this study quantified the effects of soft drink consumption compared to water on glucose and lipid metabolism in a context that was reflective of typical daily consumption levels, meal patterns and activity behaviours such as sitting for long periods.

The study, involved 28 overweight or obese adults aged 19–30 years who were habitual soft drink consumers. They participated in two separate experiments on different days drinking soft drink on one and water on the other both mid-morning and mid-afternoon during a 7-hour day of uninterrupted sitting.

Professor Kingwell says the combination of soft drink and prolonged sitting significantly elevated plasma glucose and plasma insulin, while reducing circulating triglycerides and fatty acids which indicates significant suppression of lipid metabolism, particularly in males.

She says the metabolic effects of a regular diet of soft drink combined with extended periods of sitting may contribute to the development of metabolic disease in young people who are overweight or obese, including predisposing men to an elevated risk of fatty liver disease.

“The acute metabolic effects outlined in this study are very worrying and suggest that young, overweight people who engage in this type of lifestyle are setting themselves on a path toward chronic cardiometabolic disease,” Professor Kingwell says. “This highlights significant health implications both for individuals and our healthcare system.”

Part 2 : Here’s what’s going on inside your veins after you drink a soft drink

Orginally published Here

Half an hour after finishing a can of soft drink, your blood sugar has spiked.

So you’re probably feeling pretty good. Your cells have plenty of energy, more than they need.

Maybe that soft drink had some caffeine as well, giving your central nervous system a kick, making you feel excitable, suppressing any tiredness you might have.

But a clever new study, published this week, nicely illustrates that while you’re feeling good, strange things are going on inside your blood vessels – and in the long run they are not good for you.

For this study, 28 obese or overweight young adults agreed to sit in a lab for a whole day while having their blood continuously sampled.

The volunteers ate a normal breakfast, lunch and dinner. At morning tea and afternoon tea, researchers from Melbourne’s Baker Heart and Diabetes Institute gave them a can of soft drink.

Their blood samples revealed exactly what happened next.

Sugar from, say, a chocolate bar is released slowly, as your digestive system breaks it down.

With a can of soft drink, almost no break-down time is needed. The drink’s sugar starts to hit your bloodstream within about 30 minutes. That’s why you get such a big spike.

Your body responds to high levels of blood sugar by producing a hormone called insulin.

Insulin pumps through the bloodstream and tells your cells to suck in as much sugar as they can. The cells then start burning it, and storing what they can’t burn.

That quickly reduces the amount of sugar in the blood, and gives you a burst of energy. So far so good.

But the sugar keeps coming. High levels of blood sugar will quickly damage your blood vessels, so the body keeps making insulin.

In fact, just having two cans of soft drink meant the volunteers’ insulin stayed significantly higher than usual – all day.

After lunch, and another soft drink for afternoon tea, their sugar and insulin levels spiked again.

And, once again, over the next few hours blood sugar dropped but insulin levels stayed stubbornly high – right through to late afternoon, when the study finished.

The study demonstrates that two cans of soft drink is all it takes to give your pancreas – the crucial organ that produces insulin – a serious workout, says Professor Bronwyn Kingwell, the study’s senior author.

Watch Video 

We get more sugar each year from beverages than all the sweet treats you can think of combined.

“If you did this day in, day out, your pancreas would be under considerable stress – and this is how diabetes can develop,” says Professor Kingwell. “Having a little can of soft drink in the morning is going to have lasting effects throughout the day.”

If your diet has too much sugar in it, forcing your body to keep your insulin high all the time, eventually your cells will grow insulin-resistant. That forces the pancreas to make even more insulin, adding to its workload. Eventually, it will burn out.

But something else interesting is happening inside your body as well.

Insulin tells your body to burn sugar. But it also tells it to stop burning fat.

Normally, the body burns a little bit of both at once. But after a soft drink, your insulin stays high all day – so you won’t burn much fat, whether you’re on a diet or not.

One of the study’s participants, Michelle Kneipp, is now trying as hard as she can to kick her soft-drink habit.

She’s switched soft drinks for flavoured sparkling water. “It still tastes like soft drink, and it’s still got the fizz,” she says.

“But it’s hard, because sugar’s a very addictive substance.”

 

NACCHO Aboriginal #Mentalhealth #SuicidePrevention and #RUOKday : If you ask #RUOK ? What do you do if someone says ‘no’? Plus Sponsorships for 10 #Indigenous young people to take participate #chatsafe campaign

R U OK Day today encouraging all of us to check in with others to see if they’re OK.

But what if someone says “no”? What should you say or do? Should you tell someone else?

What resources can you point to, and what help is available?

Read NACCHO Aboriginal Health articles over the past 6 Years

Mental Health 189 posts 

Suicide Prevention 124 Posts

Here is a guide 

Stop and listen, with curiosity and compassion

We underestimate the power of simply listening to someone else when they’re going through a rough time. You don’t need to be an expert with ten years of study in psychology to be a good listener. Here are some tips:

Listen actively. Pay attention, be present and allow the person time to speak.

Be curious. Ask about the person’s experience using open questions such as

what’s been going on lately?

you don’t seem your usual self, how are you doing/feeling?

Validate their concerns. See the situation from the person’s perspective and try not to dismiss their problems or feelings as unimportant or stupid. You can say things like

I can see you’re going through a tough time

it’s understandable to feel that way given everything you’ve been going through.

There are more examples of good phrases to use here.

Don’t try to fix the problem right now

Often our first instinct is wanting to fix the person’s problems. It hurts to see others in pain, and we can feel awkward or helpless not knowing how to help. But you don’t have to have all of the answers.

Instead of jumping into “fix it” mode right away, accept the conversation may be uncomfortable and allow the person to speak about their difficulties and experiences.

Sometimes it’s not the actual suggestion or practical help that’s most useful but giving the person a chance to talk openly about their struggles. Also, the more we understand the person’s experience, the more likely we are to be able to offer the right type of help.

Encourage them to seek help.

Ask:

how can I help?

is there something I can do for you right now?

Sometimes it’s about keeping them company (making plans to do a pleasant activity together), providing practical support (help minding their kids to give them time out), or linking them in with other health professionals.

Check whether they need urgent help

It’s possible this person is suffering more than you realise: they may be contemplating suicide or self-harm. Asking about suicidal thoughts does not worsen those thoughts, but instead can help ease distress.

It’s OK to ask them if they’re thinking about suicide, but try not to be judgemental (“you’re not thinking of doing anything stupid, are you?”). Listen to their responses without judgement, and let them know you care and you’d like to help.

Read more: How to ask someone you’re worried about if they’re thinking of suicide

There are resources and programs to help you learn how to support suicidal loved ones, and crisis support lines to call:

  • Contact the Social and Emotional team at your nearest ACCHO
  • Lifeline (24-hour crisis telephone counselling) 13 11 14
  • Suicide Callback Service 1300 659 467
  • Mental health crisis lines

If it is an emergency, or the person is at immediate risk of harm to themselves or others, call 000.

Encourage them to seek professional help

We’re fortunate to be living in Australia, with access to high quality mental health care, resources and support services. But it can be overwhelming to know what and where to seek help. You can help by pointing the person in the right direction.

The first place to seek help is the general practitioner (GP). The GP can discuss treatment options (psychological support and/or medication), provide referrals to a mental health professional or arrange access to local support groups. You can help by encouraging your friend to make an appointment with their GP.

There are great evidence-based online courses and self-help programseducational resources and free self-help workbooks that can be accessed at any time.

There are also online tools to check emotional health. These tools help indicate if a person’s stress, anxiety and depression levels are healthy or elevated.

What if they don’t want help?

People with mental health difficulties sometimes take years between first noticing the problem and seeking professional help. Research shows approximately one in three people experiencing mental health problems accesses treatment.

So even if they don’t want help now, your conversation may have started them thinking about getting help. You can try understanding what’s stopping them from seeking help and see if there’s anything you can do to help connect them to a professional. You don’t need to push this, but simply inviting the person to keep the options in mind and offering your ongoing support can be useful in the long run.

Follow up. If appropriate, organise a time to check in with the person again to see how they’re doing after your conversation. You can also let the person know you’re around and they are always welcome to have a chat with you. Knowing someone is there for you can itself be a great source of emotional support.

Read more: Five types of food to increase your psychological well-being

The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences bursary

Orygen, The National Centre of Excellence is seeking expressions of interest (EOI) from all Aboriginal and Torres Strait Islander young people who would like to share their expertise, advice, and ideas and contribute to the development of a suicide prevention social media campaign!

About the #chatsafe campaign

We would like to partner with Aboriginal and Torres Strait Islander young people to co-design a suicide prevention social media campaign specifically for the Aboriginal community. The campaign will focus on educating and empowering young people to support themselves and other young people within their online social networks. Rather than speaking on behalf of Aboriginal communities, we wish to draw on the expertise, cultural identities, and strengths of the community to inform campaign materials.

The co-design workshop will involve a yarning circle, where young people will be given the opportunity to share their experiences and express their needs. The yarning circle will be facilitated by an Aboriginal and Torres Strait Islander person. The workshop will also involve working together, in groups, to generate ideas for a social media campaign (e.g., digital storytelling, drawing, etc.).

The workshop will be hosted in Perth, as a part of the The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences. The workshop will be conducted in the morning and breakfast will be provided. Young people will be reimbursed $30.00 per hour for their time.

Opportunity for financial support

Oyrgen would like to sponsor 10 Aboriginal and Torres Strait Islander young people to take part in our co-design workshop and The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences, hosted from 20 to 23 November, in Perth, by providing a bursary.

SEE CONFERENCE WEBSITE

Eligibility

To be eligible for Orygen’s bursary funding, the applicant must be an Aboriginal and Torres Islander young person, aged between 18 and 25 years. We encourage young people from all geographic regions, across Australia, to apply.

Submitting your application

If you would like to be a part of the co-design workshop, please email your application to Jo at

The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences bursary

Orygen, The National Centre of Excellence is seeking expressions of interest (EOI) from all Aboriginal and Torres Strait Islander young people who would like to share their expertise, advice, and ideas and contribute to the development of a suicide prevention social media campaign!

About the #chatsafe campaign

We would like to partner with Aboriginal and Torres Strait Islander young people to co-design a suicide prevention social media campaign specifically for the Aboriginal community. The campaign will focus on educating and empowering young people to support themselves and other young people within their online social networks. Rather than speaking on behalf of Aboriginal communities, we wish to draw on the expertise, cultural identities, and strengths of the community to inform campaign materials.

The co-design workshop will involve a yarning circle, where young people will be given the opportunity to share their experiences and express their needs. The yarning circle will be facilitated by an Aboriginal and Torres Strait Islander person. The workshop will also involve working together, in groups, to generate ideas for a social media campaign (e.g., digital storytelling, drawing, etc.). The workshop will be hosted in Perth, as a part of the The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences. The workshop will be conducted in the morning and breakfast will be provided. Young people will be reimbursed $30.00 per hour for their time.

Opportunity for financial support

Oyrgen would like to sponsor 10 Aboriginal and Torres Strait Islander young people to take part in our co-design workshop and The 2nd National Aboriginal and Torres Strait Islander Suicide Prevention and World Indigenous Suicide Prevention Conferences, hosted from 20 to 23 November, in Perth, by providing a bursary.

Eligibility

To be eligible for Orygen’s bursary funding, the applicant must be an Aboriginal and Torres Islander young person, aged between 18 and 25 years. We encourage young people from all geographic regions, across Australia, to apply.

Submitting your application

If you would like to be a part of the co-design workshop, please email your application to Jo at jo.robinson@orygen.org.au. Submissions can be made on, or before Sunday, 30 September, 2018.

Selection process

In the first week of October, a panel consisting of Oyrgen staff, a Culture is Life representative, Professor Pat Dudgeon from the conference organising committee, Summer May Finlay (a Yorta Yorta woman), and young people will review all written applications and select 10 successful applicants. The selection panel will endeavour to select a diverse range of young people. The 10 successful applicants will be notified by email by mid-October. The success applicants will have until 31 October, 2018 to accept the bursary offered.

Requirements

The successful recipients of the bursaries are required to attend a half-day co-design workshop. Recipients will also be asked to complete and submit a ‘Wellness Plan’, ‘Bank Details Form’, and ‘Consent Form’ prior to participation in the w

. Submissions can be made on, or before Sunday, 30 September, 2018.

Selection process

In the first week of October, a panel consisting of Oyrgen staff, a Culture is Life representative, Professor Pat Dudgeon from the conference organising committee, Summer May Finlay (a Yorta Yorta woman), and young people will review all written applications and select 10 successful applicants. The selection panel will endeavour to select a diverse range of young people. The 10 successful applicants will be notified by email by mid-October. The success applicants will have until 31 October, 2018 to accept the bursary offered.

Requirements

The successful recipients of the bursaries are required to attend a half-day co-design workshop. Recipients will also be asked to complete and submit a ‘Wellness Plan’, ‘Bank Details Form’, and ‘Consent Form’ prior to participation in the w

Anyone seeking support and information about mental health can contact beyondblue on 1300 22 46 36. For information about suicide and crisis support, contact Lifeline on 13 11 14 or the Suicide Callback Service on 1300 659 467

 

NACCHO Aboriginal Children’s Health : Dr @SandroDemaio presents a five-point policy plan using a lifeSPANS approach to address child obesity in Australia: #NCDs #EnoughNCDs @FAREAustralia @AHPA_AU @SaxInstitute

 

” The answer to obesity will never be in telling people what to do, guilting them for making unhealthier choices in a confusing consumption landscape, or by simply banning things. We also know that education and knowledge will get us only so far.

The real answers lie not even in inspiring populations to make hundreds of healthier decisions each and every day in the face of a seductively obesogenic, social milieu.

If we are to drive long‐term, sustained and scalable change, we must tweak the system to ensure those healthier choices become the path of least resistance—and eventually preferred. And I believe we must focus, initially, on our kids.

It is time for a lifeSPANS approach to addressing obesity in Australia.”

Dr Alessandro Demaio ” A $100 Million question ” see Bio in full Part 2

Download this Paper HERE : Demaio-2018-Health_Promotion_Journal_of_Australia

Listen to Dr Sandro’s childhood obesity Podcast HERE 

  ” The 2012-13 Health Survey identified that Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians, with the prevalence increasing more rapidly in Aboriginal school-aged children.

Overweight and obesity in childhood are important predictors of adult adiposity, increasing the risk of developing a range of medical conditions, each of which is a major cause of morbidity, mortality and health expenditure.

While it is surprisingly clear what needs to be done to improve the health of Indigenous children, recent cuts to Indigenous preventative workforce and nutrition programs throughout Australia have severely reduced the capacity to respond.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care.

The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve. “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

Compelling populations, individuals or even ourselves to act pre‐emptively on the urgent and massive challenges of tomorrow is notoriously difficult.

The concept is called temporal or future discounting, and it is well documented.1 It is the idea that we prioritise our current comfort and happiness over our future and seemingly distant safety or wellbeing.

This psychological shortcoming plays out in many ways. At the micro level, we may defer until next week what we should do today—that run, drinking more water or the dentist check‐up—as it may not reap benefits for months, or ever. Eventually, we may act on some of these but whether delayed, deferred or denied, it can reap serious health consequences.

At the macro level, it becomes even more problematic. When we combine this “delay what’s beyond tomorrow” phenomenon with short‐term political cycles in the context of systems‐based, slowly evolving and largely invisible future threats, important but not yet imminent issues are not just postponed, but ignored.

Few challenges are a greater threat to the health of Australians, nor better define future discounting, than obesity. At the individual level and in our modern, obesogenic societies, weight gain has become the norm—the biological and social path of least resistance.

Food systems have shifted from a focus on seasonal, fresh and relatively calorie‐poor staples with minimal processing or meat, to an environment where junk foods and processed foods are ubiquitous, heavily advertised, hugely profitable and, for many communities, the only feasible “choice”.

Poor nutrition is now the leading risk factor for disease in our country.2City living has come with benefits, but along with an increasingly automated and digitalised lifestyle, has seen physical activity become something we must seek out, rather than an unavoidable component of our daily lives. Factors such as these have made individual action difficult for most of us and combined with our biology, have contributed to obesity rates more than doubling in Australia since 1980 alone.3

At the policy level, a dangerous, pernicious and unhealthy status quo has evolved over decades. One which sees a population increasingly affected by preventable, chronic disease. One which can only be solved through difficult decisions from politicians and the public to make the short‐term, passive but unhealthy comfort harder; and the long‐term promise of wellbeing more attractive.

One which must see sustained public demand and political commitment for a distant goal and best scenario of nil‐effect, in the face of constant, coordinated and powerful pushback, threats and careful intimidation from largely unprecedented policy counter‐currents.

But opportunities do exist; levers throughout this gridlocked policy landscape that can be utilised to move the obesity agenda forward.

One of those is our kids.

We know that if we cannot prevent obesity in our children, those young Australians will likely never achieve wellbeing.

We know that one in four of our children is overweight or obese and that while 5% of healthy weight kids become obese adults, up to 79% obese children will never realise a healthy weight.45 We know that the school years are a time when major weight gain occurs in our lifecourse and almost no one loses weight as they age.6

Recent evidence suggests early, simple interventions not only reduce weight and improve the health for our youngest kids, but also reduce weight in their parents.78 An important network of effective implementation platforms and primed partners already exist in our schools and teachers around the nation.

Finally, a large (but likely overstated) proportion of Australians may call “nanny state” at even the whiff of effective policies against obesity, but less so if those policies are aimed at our children.

With this in mind, I was recently invited to Canberra to present on how I would spend an extra $100 million each year on preventive health for the nation.

This is the five‐point policy plan I proposed; a lifeSPANS approach to addressing child obesity—and with it, equipping a new generation of Australians to act on tomorrow’s risks, today. This is an evidence‐based package to reduce the major sources of premature deaths, starting early.

1 .SCHOOLS AS PLATFORMS FOR HEALTH

  • $3 million to support the revision and implementation of clear, mandatory guidelines on healthy food in school canteens
  • $3 million to coordinate and support the removal of sales of sugary drinks
  • $13 million to expand food and nutrition programs to remaining primary schools
  • $40 million as $5000‐10 000 means‐tested grants for infrastructure that supports healthy eating and drinking in primary schools
  • $130 million to cover 1.7 million daily school breakfasts for every child at the 6300 primary schools nationally910
  • $140 million left from sugary drink tax revenue for school staffing and programs for nutrition and physical activity

Schools alone cannot solve the child obesity epidemic; however, it is unlikely that child obesity rates can be reversed without strong school‐based policies to support healthy eating and physical activity. Children and adolescents consume 19%‐50% of daily calories at school and spend more time there than in any other environment away from home.11 Evidence suggests that “incentives” are unlikely to result in behaviour change but peer pressure might.12 Therefore, learning among friends offers a unique opportunity to positively influence healthy habits.

Trials have demonstrated both the educational and health benefits of providing free school meals, including increased fruit and vegetable consumption, knowledge of a healthy diet, healthier eating at home and improved school performance. Providing meals to all children supports low‐income families and works to address health inequalities and stigma.10

School vending machines or canteens selling sugary drinks and junk foods further fuel an obesogenic, modern food environment. Sugary drinks are the leading source of added sugar in our diet in Australia and are considered a major individual risk factor for non‐communicable diseases, such as type 2 diabetes.13 Removing unhealthy foods and drinks from schools would support children, teachers and parents and send a powerful message to communities about the health harms of these products.

Finally, it is not only about taking things away but also supporting locally driven programs and the school infrastructure to support healthier habits. Drinking fountains, play equipment and canteen hardware could all be supported through small grants aimed at further empowering schools as decisions makers and agents for healthier kids.

2.PRICING THAT’S FAIR TO FAMILIES

  • 20% increase in sugary drinks pricing with phased expansion to fast foods over three years, unlocking approximately $400 million in annual revenue to add to existing $100 million for prevention
  • More than $600 million in annual health savings expected from sugary drinks price increase of 20%
  • $10 million for social marketing campaigns to explain the new policy measures, and benefits to community
  • Compensation package for farmers and small retailers producing and selling sugary drinks (cost unknown but likely small)
  • Such legislation would also support industry to reformulate or reshape product portfolios for long‐term market planning

Today’s food environment sees increased availability of lower cost, processed foods high in salt, fats and added sugars.14 People have less time to prepare meals and are influenced by aggressive food marketing. This leads to food inequality with those from low socioeconomic backgrounds at greater risk from obesity. Obesity increases the risks of cardiovascular disease, type 2 diabetes, stroke, cancer, mental health issues and premature death.15 There are also wider societal and economic costs amounting to an estimated $8.6 billion spent in the health sector alone annually.16

Food prices should be adjusted in relation to nutritional content. Policy makers must shift their pricing focus to integrate the true societal cost of products associated with fiscally burdensome disease. In 2016, a WHO report highlighted that a 20% increase in retail price of sugary drinks lowers consumption as well as obesity, type 2 diabetes and tooth decay.17

The landmark peso per litre sugar tax from Mexico highlighted the behaviour change potential such policies possess. Sales of higher priced beverages decreased substantially in subsequent years. Importantly, the most significant decreases occurred among the poorest households.18 For Australia, a similar approach is estimated to lead to $609 million in annual health savings and raise $400 million in direct revenue.16

These legislative approaches should be framed as an expansion of our existing GST and would encourage industry to reformulate products, positively influencing the food environment.131517

This is not a sin tax or ban, it is an effective policy and pricing that is fair to families. It is also backed by evidence and supported by the public.19

3. ADVERTISING THAT SUPPORTS OUR KIDS

  • End all junk food marketing to children, and between 6 am and 10 pm on television
  • End the use of cartoons on any food or drink packaging
  • $30 million to replace junk food sponsorship of sport and arts events with healthy messaging and explanation of lifeSPANS policy approach
  • Phased expansion of advertising ban over three years to all non‐essential foods (GST language)

The food industry knows that marketing works, otherwise they would not spend almost $400 million annually on advertisements in Australia alone.20

Three of four commercial food advertisements are for unhealthy products and evidence suggests that food advertising triggers cognitive processes that influence our food choices, similar to those seen in addiction. Studies also demonstrate that food commercials including the use of cartoons influence the amount of calories that children consume and the findings are particularly pronounced in overweight children.21

Fast food advertising at sporting and arts events further reinforces a dangerous and confusing notion that sees the direct association between societal heroes or elite athleticism and the unhealthiest of foods.

Ending junk food advertising to children, including any use of cartoons in the advertisement of food and drinks, is an important step to support our kids.

4.NUTRITION LABELLING THAT MAKES SENSE TO EVERYONE

  • Further strengthen existing labelling approaches, including mandatory systems

Nutritional information can be confusing for parents, let alone children. Food packaging often lists nutritional information in relation to portion size meaning a product with a higher figure may simply be larger rather than less healthy. While the Health Star Rating system, implemented in 2014, has made substantive progress, it remains voluntary.22

Efforts should be made to strengthen the usability of existing efforts and make consistent, evidence‐based and effective labelling mandatory. Such developments would also provide stronger incentives for manufacturers to reformulate products, reducing sugar, fat and salt content.

Clearer and consistent information would help create a more enabling food environment for families to make informed choices about their food.

5.SUPPLY CHAIN SYSTEMS AS SOLUTION‐CATALYSTS

  • Utilise procurement and supply chains of schools and public institutions to drive demand for healthier foods
  • Leverage the purchasing power of large organisations to reduce the costs of healthy foods for partner organisations and communities

Coordinated strategies are needed to support the availability of lower cost, healthy foods for all communities. Cities and large organisations such as schools and hospitals could collaborate to purchase food as collectives, thus driving demand, building market size and improving economies of scale.23

By leveraging collective purchasing power, institutions can catalyse the availability of sustainable and healthy foods to also support wider, positive food environment change.

Part 2

Dr Alessandro Demaio, or Sandro, trained and worked as a medical doctor at The Alfred Hospital in Australia.

While practicing as a doctor he completed a Master in Public Health including fieldwork to prevent diabetes through Buddhist Wats in Cambodia. In 2010, he relocated to Denmark where he completed a PhD with the University of Copenhagen, focusing on non-communicable diseases. His doctoral research was based in Mongolia, working with the Ministry of Health.

He designed, led and reported a national epidemiological survey, sampling more than 3500 households. Sandro held a Postdoctoral Fellowship at Harvard Medical School from 2013 to 2015, and was assistant professor and course director in global health at the Copenhagen School of Global Health, in Denmark.

He established and led the PLOS blog Global Health, and served on the founding Advisory Board of the EAT Foundation: the global, multi-stakeholder platform for food, health and environmental sustainability.

To date, he has authored over 23 scientific publications and more than 85 articles and blogs. In his pro bono work, Dr Demaio co-founded NCDFREE, a global social movement against noncommunicable diseases using social media, short film and leadership events – crowdfunded, it reached more than 2.5 million people in its first 18 months.

Then, in 2015, he founded festival21, assembling and leading a team of knowledge leaders in staging a massive and unprecedented, free celebration of community, food, culture and future in his hometown Melbourne. In November 2015, Sandro joined the Department of Nutrition for Health and Development at the World Health Organization’s global headquarters, as Medical Officer for noncommunicable conditions and nutrition.

From 2017, he is also co-host of the ABC television show Ask the Doctor – an innovative and exploratory factual medical series broadcasting weekly across Australia. Sandro is currently fascinated by systems-innovation and leadership; impact in a post-democracy; and the commercial determinants of disease. He also loves to cook.

NACCHO Aboriginal Children’s Health : Breaking News : Channel Seven in breach for Sunrise segment on #Indigenous children

 ” The Australian Communications and Media Authority (ACMA) has found that Channel Seven Sydney breached the Commercial Television Industry Code of Practice in a Sunrise ‘Hot Topics’ segment broadcast on 13 March 2018.

The ACMA found that the introduction to the segment claiming Indigenous children could ‘only be placed with relatives or other Indigenous families,’ was inaccurate and in breach of the Code. The licensee explained that this repeated a statement from a newspaper of the day. ”

See NACCHO’s  original coverage back in March

NACCHO Aboriginal Health News Alert :@sunriseon7 finally shines light on Indigenous issues, but is it a real awakening (for all media)? Report from @croakeyblog

However, the ACMA considered that Seven should have taken steps to verify the accuracy of this claim before it was used as the foundation for a panel discussion.

The ACMA noted the follow-up ‘Hot Topics’ segment broadcast by Seven on 20 March 2018 was a more informed discussion in which a panellist accurately described the true position regarding placement of Indigenous children.

However, the ACMA found that the follow-up segment did not correct the earlier error in an appropriate manner in the circumstances.

The ACMA investigation also found that the segment provoked serious contempt on the basis of race in breach of the Code as it contained strong negative generalisations about Indigenous people as a group. These included sweeping references to a ‘generation’ of young Indigenous children being abused.

While it may not have been Seven’s intention, by implication the segment conveyed that children left in Indigenous families would be abused and neglected, in contrast to non-Indigenous families where they would be protected.

‘Broadcasters can, of course, discuss matters of public interest, including extremely sensitive topics such as child abuse in Indigenous communities. However, such matters should be discussed with care, with editorial framing to ensure compliance with the Code,’ said ACMA Chair, Nerida O’Loughlin.

‘The ACMA considers that the high threshold for this breach finding was met, given thestrong negative generalisations about Indigenous people as a group,’ added Ms O’Loughlin.

The ACMA is in discussions with Channel Seven about its response to the breach findings.

Channel Seven has indicated that it may seek judicial review of the ACMA’s decision

NACCHO Aboriginal Children’s Health #Nutrition #Obesity : @IndigenousPHAA The #AFL ladder of sponsorships such as soft drinks @CocaColaAU and junk food @McDonalds_AU endangers the health of our children

 “Aboriginal and Non- Aboriginal kids are being inundated with the advertising of alcohol, junk food and gambling through AFL sponsorship deals according to a new study.

With obesity and excessive drinking remaining a significant problem in our communities, it’s time for the AFL ladder of unhealthy sponsorship (see below) to end,

Children under the age of eight are particularly vulnerable to advertising because they lack the maturity and mental skills to evaluate the messages. Therefore, in the case of the AFL, they begin to associate unhealthy products with their favourite sport and players

We need to ask ourselves why Australia’s most popular winter sport is serving as a major advertising platform for soft drink, beer, wine, burgers and meat pies. It’s sending the wrong message to Australians that somehow these unhealthy foods and drinks are linked to the healthy activity of sport,”

Says the Public Health Association of Australia (PHAA).

Read all NACCHO Aboriginal Health Nutrition / Obestity articles over 6 years HERE 

In the study published this week in the Australian and New Zealand Journal of Public Health, Australian researchers looked at the prevalence of sponsorship by alcohol, junk food and gambling companies on AFL club websites and on AFL player uniforms.

The findings were used to make an ‘AFL Sponsorship Ladder’, a ranking of AFL clubs in terms of their level of unhealthy sponsorships, with those at the top of the ladder having the highest level of unhealthy sponsors.

The study clearly demonstrated that Australia’s most popular spectator sport is saturated with unhealthy advertising.

Download PDF Copy of report NACCHO Unhealthy sponsors of sport

Ainslie Sartori, one of the authors involved in the research confirmed, “After reviewing the sponsorship deals of AFL clubs, we found that 88% of clubs are sponsored by unhealthy food and beverage companies. A third of AFL clubs are also involved in business partnerships with gambling companies.”

Recommendation 

Sponsorship offers companies an avenue to expose children and young people to their brand, encouraging a connection with that brand.

The AFL could reinforce healthy lifestyle choices by shifting the focus away from the visual presence of unhealthy sponsorship, while taking steps to ensure that clubs remain commercially viable.

Policy makers are encouraged to consider innovative health promotion strategies and work
with sporting clubs and codes to ensure healthy messages are prominent

 

The study noted that children are often the targets of AFL advertising. This is despite World Health Organization recommendations that children’s settings should be free of unhealthy food promotions and branding (including through sport) due to the known risk it poses to their diet and chances of developing obesity.

PHAA CEO Terry Slevin commented, “When Australian kids see their sports heroes wearing a uniform plastered with certain brands, they inevitably start to associate these brands with the player they look up to and with the positive and healthy experience of the sport.”

He added, “The AFL is in a unique position to positively influence the health of Australian kids through banning sponsorship by alcohol, junk food and gambling companies. It could instead reinforce the importance of a healthy lifestyle for them.”

“Australian health policy makers need to consider innovative health promotion strategies and work together with sport clubs and codes to ensure that unhealthy advertising is not a feature. We successfully removed tobacco advertising from sport and we can do it with junk food and gambling too,” Mr Slevin said.

The recently released Sport 2030 plan rightly identifies sport as a positive vehicle to promote good health. But elite “corporate sport” plays a role of bypassing restrictions aimed at reducing exposure of children to unhealthy product marketing.

“The evidence is clear – it’s time for Australia to phase out all unhealthy sponsorship of sport,” Mr Slevin conclude

 NACCHO Aboriginal Hearing Health : #OMOZ2018 Ear Health Project Officers will spearhead a new $7.9 million #HearingforLearning program to fight hearing loss among Aboriginal and Torres Strait Islander childre

Hearing for Learning aims to dramatically lift the capacity for communities to identify ear disease within the first few months of life.

Infants rarely show signs of ear pain, so infections are not detected and diseases like otitis media persist and progress.

By 12 months of age, only five per cent of First Nations children in remote communities have bilateral normal hearing, compared with over 80 per cent of children in the rest of Australia.

Children with undiagnosed hearing loss tend to fall behind at school due to delayed speech and language development.

This can have a huge impact on their early years, future employment opportunities and their chance of a happy and successful life.”

Indigenous Health Minister Ken Wyatt AM

The Territory Labor Government promised to put children at the centre of our decision-making, because we want a brighter future for our kids – a future filled with opportunity.

When we focus on the first 1000 days of a child’s life, we know we get better outcomes for their future, and that’s what this partnership aims to do.

Hearing health has an enormous impact on a child’s development, and by addressing this at a community level, the entire community will benefit.” 

NT Chief Minister Michael Gunner

Watch video 

 

Read over 40 Aboriginal Ear and Hearing articles published by NACCHO over last 6 years

Hearing is essential for strong early childhood development and chronic hearing problems in children cause education difficulties leading to entrenched disadvantage.

The Hearing for Learning Initiative is a ground-breaking 5-year investment combining public and private funding to solve this serious health and education problem “

Professor Alan Cass Director Menzies School of Health Research

When we learned about the chronic nature of ear disease in children living in remote communities in the Northern Territory, we could not ignore the fact that this likely leads to profound disadvantage in health, education and employment outcomes.

We believe more must be done and the next step is to support the community to deliver a solution.

Philanthropy plays a unique role in recognising and piloting new approaches, however, it requires partnership with government to deliver these approaches at scale.

The Government is to be applauded for putting this unique partnership together to solve what has now become a serious epidemic.

Neil Balnaves AO, Founder, The Balnaves Foundation and Chancellor, Charles Darwin University

Dozens of local Ear Health Project Officers will spearhead a new $7.9 million program to fight hearing loss among Aboriginal and Torres Strait Islander children in the Northern Territory.

The Hearing for Learning initiative will be established in 20 urban, rural and remote sites, where up to 40 local people will strengthen and complement the work of fly-in fly-out (FIFO) ear specialists.

“This is an exciting new opportunity to remove the preventable blight of hearing loss from current and future generations,” said Indigenous Health Minister Ken Wyatt AM.

“These local ear health warriors will integrate with existing primary care services, to help protect the hearing of up to 5,000 children from birth to 16 years old.

“Lifting the capacity of local families to recognise, report and treat ear problems early promises to help our children reach their full potential.”

The initiative will be implemented by the Menzies School of Health Research and co-led by Professor Amanda Leach and Associate Professor Kelvin Kong.

The Hearing for Learning is a ground-breaking 5-year initiative by the Northern Territory Government, founded on scientific research by Northern Territory scientists at Menzies School of Health Research, combining public and private funding to solve this serious health and education problem.

$2.4 million from NT Government

$2.5 million from The Balnaves Foundation

$3 million from the Federal Government

Hearing for Learning aims to dramatically lift the capacity for communities to identify ear disease within the first few months of life,” said Minister Wyatt.

“Infants rarely show signs of ear pain, so infections are not detected and diseases like otitis media persist and progress.

“By 12 months of age, only five per cent of First Nations children in remote communities have bilateral normal hearing, compared with over 80 per cent of children in the rest of Australia.”

“Children with undiagnosed hearing loss tend to fall behind at school due to delayed speech and language development,” Minister Wyatt said.

“This can have a huge impact on their early years, future employment opportunities and their chance of a happy and successful life.”

The Menzies School of Health Research aims to make Hearing for Learning a care model that can be replicated across the nation.

Hearing for Learning will complement the Government’s existing ear health programs, including Healthy Ears, which together will receive funding of $81.8 million over four years from 2018–19.

This includes $30 million for a new outreach program to provide annual hearing assessment, referral and follow-up treatment for Aboriginal and Torres Strait Islander children before they start school.

NACCHO Aboriginal Health and local #Adoption : @CAACongress @SNAICC and @AbSecNSW streamed live today August 14 from Canberra , public hearing local adoption : Plus @AMSANTaus full submission

 

We are aware that this Inquiry was called in the wake of recent media coverage relating to the issue of adoption of Aboriginal children, including the Minister’s own comments that adoption policies should be changed to allow more Aboriginal children to be adopted by non-Aboriginal families.

AMSANT would like to emphasise the importance of informed discussion on this issue and draws the Committee’s attention to the following, put forward in March of this year as part of a joint statement from Aboriginal and Torres Strait Islander leaders in response to media coverage:

We need to have a more rational and mature discussion aimed at achieving better social, community, family and individual outcomes for all Aboriginal and Torres Strait Islander children and young people. We must work to ensure that the drivers of child protection intervention are addressed, rather than continuing with a poorly designed and resourced system that reacts when it’s too late, after families have already reached breaking point and children have been harmed1

See Full AMSANT Submission Part 2 Below

 

“As detailed in our submission, AbSec is strongly opposed to the coerced adoption of Aboriginal children by statutory child protection systems. Adoption orders are characterised by the absence of key safeguards to ensure the safety and wellbeing of Aboriginal children.

They fail to uphold an Aboriginal child’s fundamental rights to family, community and culture, and the importance of these connections to our life long wellbeing and resilience. They are not in the best interests of our children.

In particular, it must be noted that past policies of the forced separation of Aboriginal children and young people from their families, communities, culture and Country is regarded as a key contributor to this ongoing over-representation. It is not a solution.

AbSec, alongside QATSICPP and SNAAICC, call for the development of Aboriginal and Torres Strait Islander community-led approaches to the care of our children “

ABSEC Submission Download Here

ABSEC Adoption submission

SNAICC Submission Download Here

Snaicc Adoption submission

 Part 1 Next public hearing for local adoption inquiry

The House of Representatives Standing Committee on Social Policy and Legal Affairs will hold a public hearing into a nationally consistent framework for local adoption in Australia.

The Committee will hear from the Central Australian Aboriginal Congress, the Secretariat of National Aboriginal and Islander Child Care – National Voice for our Children (also known as SNAICC), and the Aboriginal Child, Family and Community Care State Secretariat (NSW) (also known as AbSec).

A detailed program for the hearing is available from the inquiry webpage (www.aph.gov.au/localadoption).

Public hearing details: Tuesday 14 August, 4.40pm (approx) to 6.00pm, Committee Room 1R2, Parliament House, Canberra

The Central Australian Aboriginal Congress

SNAICC (Secretariat of National Aboriginal and Islander Child Care) – National Voice for our Children

AbSec – the Aboriginal Child, Family and Community Care State Secretariat (NSW)

The hearings will be streamed live in audio format at aph.gov.au/live.

Members of the public are welcome to attend the hearing however there will be limited seating available.

Further information about the inquiry, including the terms of reference and submissions published so far, is available on the inquiry webpage.

Part 2 AMSANT submission to The Standing Committee on Social Policy and Legal Affairs: Inquiry into local adoption

AMSANT welcomes the opportunity to provide a submission to the Inquiry into Local Adoption. As the peak body for the community controlled Aboriginal primary health care sector in the Northern Territory AMSANT advocates for equity in health, focusing on supporting the provision of high quality comprehensive primary health care services for Aboriginal communities.

This submission provides an overview of AMSANT’s position in relation to Aboriginal children in Child Protection, including Out of Home Care (OOHC) and potential adoption, and also responds directly to Terms of Reference 1 and 2 of the Inquiry.

Overview

AMSANT embraces a social and cultural determinants of health perspective which recognises that health and wellbeing are profoundly affected by a range of interacting economic, social and cultural factors. Accordingly, we advocate for a holistic and child-centred approach to Child Protection that seeks first and foremost to address the underlying causes of abuse and neglect through prevention and early intervention.

We are aware that this Inquiry was called in the wake of recent media coverage relating to the issue of adoption of Aboriginal children, including the Minister’s own comments that adoption policies should be changed to allow more Aboriginal children to be adopted by non-Aboriginal families.

AMSANT would like to emphasise the importance of informed discussion on this issue and draws the Committee’s attention to the following, put forward in March of this year as part of a joint statement from Aboriginal and Torres Strait Islander leaders in response to media coverage:

We need to have a more rational and mature discussion aimed at achieving better social, community, family and individual outcomes for all Aboriginal and Torres Strait Islander children and young people. We must work to ensure that the drivers of child protection intervention are addressed, rather than continuing with a poorly designed and resourced system that reacts when it’s too late, after families have already reached breaking point and children have been harmed1.

As captured in this statement it is essential that efforts to improve outcomes for children and families in contact with the Child Protection System stem from an understanding that abuse and neglect of children are most often the result of deeper family conflict or dysfunction, arising from social, economic and/or psychological roots.

In cases where children do need to be removed from family, decisions about what kind of placement, including adoption, is most appropriate for that child should occur in line with the following principles:

 Child-centred approach that allows for children to have a say in decisions that affect them

 OOHC for Aboriginal children delivered by Aboriginal Community Controlled Services (ACCSs)

 Adoption of a set of national standards for the rights of children in care

 Maintaining connection to family, community, culture and country, including prioritising adoption by extended family or if that is not possible, Aboriginal families who are not related.

 Improved support for kinship carers

1 See full statement here: http://www.snaicc.org.au/snaicc-statement-14-march-2018-joint-statement-aboriginal-torres-strait-islander-leaders-recent-media-coverage-around-child-protection-children/ Inquiry into local adoption

Stability and permanency for children in out-of-home care with local adoption as a viable option

Transition of OOHC to Aboriginal Community Control

Evidence clearly demonstrates that culturally competent services lead to increased access to services by Aboriginal children and their families2. Aboriginal led and managed services are well-placed to overcome the many barriers that exist for Aboriginal families and children to access services3, such as:

 a lack of understanding of the OOHC system and how to access advice and support;

 a mistrust of mainstream legal, medical, community and other support services;

 an understanding of the cultural or community pressures not to seek support, in particular perceptions of many Aboriginal families that any contact with the service system will result in the removal of their child4.

As the evaluation of child and family service delivery through the Communities for Children program identifies, “Indigenous specific services offer Indigenous families a safe, comfortable, culturally appropriate environment that is easier to access and engage with.”5 In addition, they are also going to be better at locating, training and supporting Aboriginal foster carers. This provides the opportunity to increase the quality of OOHC for Aboriginal children at significant lesser cost than the current “professional” foster care arrangements that are too often being put in place for Aboriginal children.

Following the lead of NSW, who in 2012 commenced a process of transfer to community control, there is a project currently being undertaken by the Aboriginal Peak Organisations NT (APO NT), in collaboration with the NT Government, to develop a strategy for the transition of OOHC to Aboriginal community control in the NT. Victoria has also confirmed that all OOHC service provision for Aboriginal children and families will be provided by community controlled services, with Queensland and Western Australia both exploring similar shifts.

AMSANT supports APO NT’s vision that Aboriginal children and young people in out of home care, as a priority, are placed with Kinship or Aboriginal foster carers and supported to retain culture, identity and language.

Strengthening the voice of children in decisions that affect them

Article 12 of the United Nations Convention on the Rights of the Child states; “Children have the right to say what they think should happen when adults are making decisions that affect them and to have their opinions taken into account” 6.

There is a need for Child Protection proceedings to be more responsive to the child’s aspirations and needs. An approach taken in Family Law known as child-inclusive family dispute resolution has been shown to produce better outcomes for families with parenting disputes, including greater stability of care and contact patterns, and greater contentment of children with those arrangements7. Central to this approach is the use of an independent, specially trained child health professional to conduct interviews before any decision is made about them.

There is no reason why a similar approach couldn’t be taken in terms of long term care arrangements for children but with specific provisions for continuing contact with family and community.

Maintaining connection with family, kin and country

In line with international convention, Aboriginal children and families have the right to enjoy their cultures in community with their cultural groups (UNCRC, article 30; UNDRIP, articles 11-13). This right has been enshrined in these conventions to reflect the wealth of evidence that show culture, language and connection to country are protective factors for at-risk communities8.

The Aboriginal Torres Strait Islander Placement Principle (ATSIPP) has been developed to ensure recognition of the value of culture and the vital role of Aboriginal children, families and communities to participate in decisions about the safety and wellbeing of children.

Despite the commitment from all States and Territories to fully implement this principle under the National Framework for Protecting Australia’s Children, in 2015 only 34.7% of Aboriginal children in the NT were placed in care in accordance with the Child Placement principle, compared with a national average of 65.6%, and only 3.3% of children were placed with relatives or kin, compared with 48.8% at the national average9.

This reflects the need for better practice relating to kinship care in the NT including;

– early identification of kinship networks when the child first comes to the attention of Child Protection, rather than when a crisis point has been reached;

– increased access to supports and training for kinship carers (see below);

– support services to birth parents to strengthen the option for reunification;

– development of cultural support plans for all Aboriginal children to ensure meaningful connection to family, culture and community is maintained.

Improved support for kinship carers

A lack of adequate support for kinship carers can contribute to placement breakdown, and escalation for children and young people in the statutory OOHC system, including entry into residential care.

Conversely, home based care and placement stability are associated with a range of better health, education, economic and wellbeing outcomes.

Improved access to the following would support kinship carers in maintaining more stable placements for the children in their care:

– Ensure a comprehensive assessment of the child has been conducted and a care plan, incorporating cultural supports for Aboriginal children, is developed and fully implemented.

– Ensure access to training courses across a broad range of issues (parenting solutions, behavioural management, understanding and responding to trauma etc.)

– Increased financial support to bring payments in line with foster carers.

It is important to note that even for many long-term, stable care arrangements, including for children in kinship care, adoption may not be seen as a viable option due to the loss of supports that would be incurred in transitioning from ‘carer’ to ‘parent’.

In this way it is clear that the type of placement reflects neither stability and permanency nor wellbeing for the child, but rather the particular vulnerabilities and needs of the child and their carer. Adequately meeting these needs should remain the paramount focus of any efforts to create stable, loving homes for children in care.

Appropriate guiding principles for a national framework or code for local adoptions within Australia

In order to ensure that the rights and needs of the child remain central to all Care and Protection operations, AMSANT advocates that Australia adopt a set of national standards that set out the rights of children in care, which would be modelled on the Council of Europe’s 2005 Recommendation on the Rights of Children Living in Residential Institutions10.

This recommendations sets out a list of basic principles, specific rights of children living in residential institutions and guidelines and quality standards in view of protecting the rights of children living in residential institutions, irrespective of the reasons for and the nature of the placement. It advocates that the placement of a child should remain the exception and that the placement must guarantee full enjoyment of the child’s fundamental rights.

 

NACCHO Aboriginal #Hearing Health News : 1.⁦⁦⁩#Earhealthforlife 2. Delegates gather for #OMOZ2018 to help close the hearing gap 3. #Hearing #Mentalhealth #communications

” The Otitis Media Australia Conference (OMOZ) this week in Darwin will attract Australia’s leading ear health investigators.

Darwin is a significant location for @OMOZ_2018 as the NT has the highest recorded prevalence of otitis media in the world, up to 90% of children in some communities.

OMOZ provides a forum for all researchers, clinical practitioners, health workers, policy makers, audiologists, speech therapists, ENT surgeons, consumers, educators and primary health care services investigating the prevention and treatment of chronic ear disease and hearing loss in Australia. “

See Part 1 Below to Download full OMOZ 2018 Program 

Conference Website

Read over 40 NACCHO Ear health and hearing articles

 ” The #EarHealthForLife network is committed to a national Aboriginal and Torres Strait Islander Hearing Health Taskforce that can provide evidence-based advice to Government about hearing health. Recognising the extent of missing data and inconsistent metrics on hearing health acrossAustralia, we are also committed to better embedding hearing health in the Closing the Gap targets and associated strategies, and an agreed national standard “

 Part 2 Download Here : Ear Health for Life Booklet A national approach to monitoring ear health

2018-05-15_earhealthforlife_booklet

 “Hearing loss is widespread among Indigenous people because of endemic childhood ear disease. This hearing loss has been described by a senate enquiry as ‘the missing piece of the puzzle in Indigenous disadvantage’[20]. This article seeks to explore a too long neglected issue that, when addressed, has the capacity to improve life outcomes for many Indigenous Australians.

The neglect of this issue in part arises because these communication issues are not‘visible’to those affected or those they communicate with. The hearing loss happens so early and so pervasively that is often ‘normalised’ among those affected.

These origins of communications problems are often obscured by a focus on cross cultural differences as sufficient explanation of communication difficulties that are evident. Most mental health workers are currently ill equipped to understand the communicative needs of people with listening difficulties and the common consequential psycho-social problems.”

Howard D, Barney J (2018) Minced words: the importance of widespread hearing loss as an issue in the mental health of Indigenous Australians. Read Extracts part 3 Below 

Part 1 Download Program 

OMOZ 2018 Program pdf

The conference provides an opportunity to share and learn about the latest evidence-based research and best practice treatment and prevention methods. All aspects of science, public health, policy, pathology, surgery, technology, hearing services, education and community engagement will find an audience. Indigenous researchers, practitioners and officeholders are encouraged to attend.

OMOZ 2018 is committed to excellence in evidence-based research and practice to reduce rates of otitis media and hearing loss in Australia.  This biannual conference encourages innovation by collaborating to find new approaches to solving this problem.

Part 3 Introduction

Download full Paper HERE

bulletin_review_howard final

When we think of people who are hard of hearing, we generally think of someone over fifty who has noise-induced hearing loss.

This stereotype is largely accurate for non-Indigenous Australians. Among this group, 85 per cent of people that are hard of hearing are over fifty [1].

The situation is very different for Indigenous Australians. Among them, hearing loss is far more pervasive and occurs across the entire age profile [2]. This is mainly due to the high incidence of middle ear disease among Indigenous children.

One of childhood’s most common illnesses, otitis media often causes conductive hearing loss [3].

This condition may be temporary, but when it recurs persistently, the cumulative total of time that children spend with ear disease can be substantial.

Crucially, the associated hearing loss occurs during critical periods of development in auditory, cognitive and psycho-social competencies [4, 5].

Persistent ear disease can damage the middle ear structures in ways that result in some degree of permanent mild-to-moderate conductive hearing loss [3]. Thus, from very early on in children’s lives otitis media can result in fluctuating mild-to-moderate levels of hearing loss, auditory processing problems and even permanent hearing loss. Individually and in combination, these impacts can have adverse effects on the psycho-social development of a child, with significant lifelong consequences.

Conversely, people who experience hearing problems later in life have already acquired their language skills, coped with schooling and completed major stages of their family and occupational life. When children experience early onset hearing problems, their cognitive and psycho-social development and subsequent engagement in family life, education and employment can all be affected. The younger the age at which hearing loss occurs, the greater the impacts across life [4, 6].

A common consequence of frequent mild to moderate conductive hearing loss from childhood ear disease is auditory processing problems, which can manifest as greater difficulties understanding what is said when it is noisy [7].

Auditory processing has been described as ‘what we do with what we hear’; how the brain processes the sounds perceived. Long periods of fluctuating hearing loss during critical developmental periods can impact markedly on a child’s auditory processing skills development [7]. Auditory processing problems can exist after hearing loss from ear disease has been resolved, or co-exist with permanent hearing loss from persistent ear disease

Acoustic environment

The acoustic environment greatly influences communication outcomes for people with hearing loss and auditory processing problems. In a good listening environment (where the signal being listened to is loud enough to be easily heard and there is little background noise), people with mild listening difficulties may cope almost as well as those with no hearing problems.

In an adverse acoustic environment, however, people with hearing loss and/or auditory processing problems often find it more challenging to understand what is said as compared to others[15].

Thisdiscrepancy in performance can be difficult for others to understand and can give rise, firstly, to people with listening problems thinking they are less intelligent or less competent than others, and, secondly, to others thinking ‘they can hear when they want to’.

That is, they are judged as not motivated to listen or purposefully ignoring what is said. These kinds of damaging judgments can initiate a cascade of social and emotional problems. Children are often excluded from social connections with family and friends, may be blamed and punished for not listening, or develop self-damaging negative beliefs about their own capacity.

Psycho-social outcomes related to early problems understanding what is said

Non-Indigenous people with hearing loss describe experiencing more anxiety, depression and interpersonal problems [8, 9, 10]. Non-Indigenous Australian children with a history of middle ear disease also report more psycho-social problems [11].

Indigenous children and adults have been found to have more behavioural problems [12, 13] and social problems [14], whilst Indigenous adults with listening problems describe higher levels of psychological distress [6]. Many of Indigenous clients working with psychologists will have mild hearing loss and/or auditory processing problems that contribute to their presenting problems. In our experience, often neither the practitioner nor client are aware of this important factor influencing communication and presenting mental health problems. Cross cultural issues often contribute to this invisiblity

Cross-cultural factors obscure hearing problems

Hearing loss and auditory processing problems among Indigenous people are often obscured by a focus solely on cultural differences as sufficient explanation for certain responses; responses that are in fact related to hearing loss and/or auditory processing problems. These include misunderstanding what is said, extreme shyness, taking longer to respond or not responding in conversation

Indigenous people with communication problems related to hearing loss often experience greater difficulties in unfamiliar Western environments. These problems inhibit the ability to learn what is needed in order to operate effectively in non-Indigenous cultural domains [6]. People may avoid engagement with certain non-Indigenous people and contexts because the unfamiliar social processes are challenging.

Regular avoidance of contact with non- Indigenous people and processes thus acts to restrict exposure to cross cultural experiences. Over time, this means that people with hearing problems don’t have the same level of opportunity to develop a better understanding of Western cultural processes.

This regular avoidance and resulting limited cross-cultural understanding means that what begins as difficulties in understanding what is said, evolves into problems fully understanding what is heard and observed in culturally unfamiliar contexts.

An implication of this is that achieving successful engagement with Indigenous people with hearing loss and/or auditory processing problems often requires facilitation by known Indigenous people within familiar cultural processes [12]. Family members and friends are often crucial to interpret and provide communication support to enable successful engagement.

Issues in mental health practice

Widespread hearing loss and auditory processing problems among Indigenous people have a number of implications for mental health practice.

Enabling Compensatory Strengths

There is inevitably a history of negative social experiences as a result of early and frequent hearing loss. A strengths focused approach is generally recommended for work with Indigenous clients [16]. This is especially important to counter the frequent criticisms from others and habitual negative self-perceptions when people have had longstanding difficulties in understanding what is said to them. Helping clients to recognise their strengths, including the compensatory strengths that are commonly developed in response to hearing difficulties can help to create a reframed self-perception. One that is more realistic, positive and resilient. Common compensatory strengths developed include the following.

Visual Observation

People with early onset hearing loss and auditory processing problems often develop sophisticated and astute powers of visual observation. Their skills include lip-reading, face-watching and reading body language, as well as a highly developed capacity to assess attitudinal and emotional reactions from these observations.

These skills develop both from the greater focus on the use of visual cues for communication in Indigenous cultures [17], as well to compensate for the challenges experienced because of listening problems. This means communication with them that is visually rich is more successful.

In addition to exploring and recognising a client’s visual strengths, it can be helpful to make use of these skills for communication during sessions. For example, a practitioner can use visual materials to support explanations of different points; using a white board, or a tablet, or just pen and paper.

Social support

Indigenous cultures foster problem solving through mutual social support. Seeking help to clarify communications by familiar people who can be trusted not to judge or shame is one of the most common coping strategies used by Indigenous people with hearing loss.

Familiarity

Being familiar with people and social processes greatly reduces listening demands. Where one person has established a positive relationship with another, it provides a framework of shared knowledgethatfosterssuccessfuluseofavarietyofcommunication skills.

“You have to know the person to read their expressions, not all mean exactly the same. With new people I can’t judge what they mean, so it’s hard to know when they’re joking, angry, sad, etc. unless I know them.” (Indigenous worker with auditory processing problems) [6, p23].

Anticipation

Being familiar with processes and people, enables people with hearing loss to make assumptions about topics that will be likely talked about. This involves habitually thinking ahead, trying to anticipate what will happen next, what will be said and to plan what they may want to say or ask in response. When they anticipate accurately, conversation is more predictable, and communication becomes more successful.

Anticipation is commonly used to cope with expressive language problems that often co-exist with comprehension problems because of hearing loss and/or auditory processing problems. People are often shamed if put on the spot in a conversation to speak about something. They have difficulties or need more time to formulate what to say. Being judged because of such difficulties in expressing themselves commonly prompts stress and anxiety.

Being able to anticipate what will be talked about helps to avoid being shamed by faltering efforts to express themselves. Expressive language problems related to childhood ear disease should be considered when clients display ‘scripted monologues’ during sessions or meetings. They may talk their way through the monologue, often ignoring or appearing discomfited by interruptions. It may be difficult for them to respond to questions until they have finished their prepared talk.

Avoidance

When dealing with unfamiliar people and unfamiliar processes, people with listening problems often experience anxiety and this can lead to using avoidance tactics to resolve their discomfit. For example, children with hearing loss may not answer a question in class [12, 14] or they may avoid going to school [18]; a patient may not attend an appointment with an unknown medical specialist [19]; or an employee with limited literacy may avoid literacy support training [6]. This type of avoidance limits engagement and the benefits to be gained from greater engagement with schooling, health, training, employment and psychological services.

Avoidance is the least successful of the above coping strategies and often contributes to limiting social, educational and occupational opportunities.

Managing listening overload

Whatever the setting, most psychologists tend to rely on ‘talking therapies’. However, clients who make extensive use of the above cognitively demanding strategies will tire more quickly than others in intensive listening situations – there is a danger of experiencing‘listening overload’. People may listen for a time, then ‘tune-out’, too tired for further effort to understand. At these times, discussions are liable to be experienced as a sequence of poorly understood, disconnected verbal interactions; ‘minced words’. The indication that someone is no longer ‘listening effectively’ is often that ‘face-watching’ ceases and is replaced by an unfocused gaze and minimal or ‘off the topic’ responsiveness.

Overall, it is often helpful to structure talk differently in sessions when working with clients with listening problems. The following list outlines some of these:

* Talk less and about what’s most important.

* Where possible give an overview of what sessions will cover.

* If ‘listening overload’ is evident consider having shorter sessions or including activities that are less demanding on listening capacity.

* Highly visual pre-reading is helpful, if there are no literacy problems.

* Use diagrams and illustrations to help explain.

* Clearly indicate when you are changing the topic of conversation.

* Use language the client knows and consider the experiences that are familiar to them.

* Create pattern and structure in discussions where possible, to help clients anticipate.

* Give the client written notes, (text messages, email or hand written) about what was discussed in the session.

* In group work, give clients forewarning about being asked to speak publicly and on what topic.

* Also in group sessions actively minimise ‘cross talk’, where some participants have private conversations that create background noise that obscures the main conversation.

Therapy techniques that demand minimal listening (EMDR, art therapy) are often more comfortable for clients with listening problems than those that require a lot of listening and talking. Overall, consider that clients with listening problems may like to have clear expectations about what will happen next during sessions, so they can mentally anticipate what may be said to them and what they may like to say. When they know what is ahead they are more likely to return and participate in constructive ways.

The use of hand held amplification devices should also be considered with some clients, if acceptable to them. These are devices about the size of a mobile phone that amplify the speaker’s voice to the client who listens through headphones. These devices are especially useful if discussions do take place in noisy environments. Amplification during any large group presentations, with a microphone that can be handed around, is highly desirable.

Discussion 

Hearing loss is widespread among Indigenous people because of endemic childhood ear disease. This hearing loss has been described by a senate enquiry as ‘the missing piece of the puzzle in Indigenous disadvantage’[20]. This article seeks to explore a too long neglected issue that, when addressed, has the capacity to improve life outcomes for many Indigenous Australians.

The neglect of this issue in part arises because these communication issues are not‘visible’to those affected or those they communicate with. The hearing loss happens so early and so pervasively that is often ‘normalised’ among those affected. These origins of communications problems are often obscured by a focus on cross cultural differences as sufficient explanation of communication difficulties that are evident. Most mental health workers are currently ill equipped to understand the communicative needs of people with listening difficulties and the common consequential psycho-social problems.

This article is one of the first (of hopefully many more to come) focusing on the interrelated communication and psycho-social issues arising from hearing loss and auditory processing problems among Indigenous people in Australia. What is discussed has also has relevance for many others around the world.

Middle ear disease is in large part a disease of disadvantage. It is commonly found around the world in underprivileged communities and in developing nations [23]. However, to date it has been only in ‘first world’ nations that research has mapped the prevalence of middle ear disease and associated hearing loss among disadvantaged Indigenous people. However, similar problems are likely to exist for approximately a billion people worldwide in developing nations [23].

A smaller but significant number of non-Indigenous people in Australia and elsewhere also are likely to have psycho-social problems that have been contributed to by chronic middle ear disease in childhood, or auditory processing problems from other origins. Aside from specific cultural issues described, the information in this article is also relevant for practitioners working with them.