NACCHO Aboriginal Health and #TopEndFASD18 : “Let’s Make #FASD History” says Top End Foetal Alcohol Spectrum Disorder (FASD) forum with 6 key messages to be taken into account addressing FASD:

 ” The forum delegates agreed that there was an urgent need for action to prevent FASD in our Top End communities, and across the Northern Territory.

It is essential that our responses do not stigmatise women or Aboriginal people.

It is important that we don’t lay blame, but instead work together, to support our women and young girls.

Everyone is at risk of FASD, so everyone must be informed the harmful effects of drinking while pregnant.

Our men also need to step up and support our mothers, sisters, nieces and partners, to ensure that we give every child the best chance in life.”

A landmark Top End Foetal Alcohol Spectrum Disorder (FASD) forum* was held in Darwin on 30-31 May 2018

Read over 25 NACCHO Aboriginal Health and FASD articles published over 6 years

“ Territorians want and deserve access to high quality health services,” Ms Fyles said.

Alcohol abuse impacts on individuals, families, businesses and our community in many different ways, including the risk of causing permanent and irreversible damage to a baby if alcohol is consumed during pregnancy.

That’s why reducing alcohol related harm is a key priority of the Territory Labor Government.

Our Government will develop a whole of government framework to prevent FASD with universal and targeted strategies to address FASD “

Minister for Health, Natasha Fyles, today welcomed 180 delegates to the inaugural Top End Foetal Alcohol Spectrum Disorder Forum in Darwin see Ministers Press Release Part 2 below

#TopEndFASD18  Bringing together Aboriginal leaders, FASD experts, Aboriginal community-controlled organisations, government representatives, medical professionals, and Non-Government organisations. Approximately 180 delegates representing 37 organisations across the Northern Territory.

FASD is often considered to be a ‘hidden’ disability, because more often than not, the physical characteristics of the individual are not easily recognised. Instead, an individual may present with learning and behavioural difficulties, which may present for a range of disorders.

As a result, FASD is not easily identified and individuals can go undiagnosed and receive inadequate treatment and support.

The forum heard from the NT Minister for Health and the Attorney General Natasha Fyles, NT Children’s Commissioner, Colleen Gwynne, Professor Elizabeth Elliott, Dr James Fitzpatrick, NOFASD and FASD Hub.

The forum also heard from Aboriginal community controlled organisations Danila Dilba, Wurli Wurlinjang, Anyinginyi Health Services, Aboriginal Medical Services Alliance Northern Territory and the North Australian Aboriginal Justice Agency.

Over two days, the forum delegates discussed the impacts of FASD on individuals, families and communities and acknowledged that alcohol misuse and its consequences are an issue for all Territorians, particularly our most vulnerable. Delegates also heard the evidence on how the prevalence of FASD impacts many of our services, including health, education and justice. Delegates learnt that trauma runs deep, and healing and making the right connections is crucial.

The delegates raised the following key messages to be taken into account in addressing FASD:

 1.Prevention and raising awareness

FASD is entirely preventable, much of its impacts are also irreversible. The harms caused by alcohol in our communities are not acceptable and we will all work together to develop prevention and intervention strategies that are culturally appropriate and relevant for our 2

people and communities. It is acknowledged that current and proposed alcohol control measures in the NT are a critical component of prevention.

2. Collaborative Approaches

The forum identified an urgent need for Aboriginal organisations, government agencies, NGOs and local communities to work together to develop policies and programs for women, men, children and communities in the Top End communities and to contribute to the development of an NT FASD Strategy. This needs to be Aboriginal community-led by the health, education, justice and child protection sectors.

 3.Access to FASD resources

It was evident that there is a need for more investment in developing culturally appropriate tools and resources for local Aboriginal communities and key stakeholders working on the frontline and also at the strategic level.

4.Assessment and Treatment services

An identified priority need is for the establishment of multi-disciplinary neuro-developmental assessment and treatment services that are strategically linked with existing service settings, including primary health care, education, child protection and the justice system.

5.Support for children and families

Research is needed to better understand how best to support children and families with FASD and other related issues that also often affect families, such as trauma. We refer to the Fitzroy Valley as a best practice model, as many strong women and leaders in the community worked in partnership with FASD experts and research institutes.

6.Workforce

The skilling and expansion of the workforce needed for prevention, assessment and treatment of FASD, particularly the community based remote Aboriginal workforce, was identified as an important need.

From this forum, we have heard the experiences about the high levels of despair and sense of disempowerment and hurt of our people and these are sad stories. We were also enlightened by the enthusiasm, dedication, passion and hope from local communities, all professions and services, that want to do more and can do more to make FASD History!

*APO NT will be producing a full report on the outcomes of the FASD Forum over the coming weeks.

Generational Change: Putting the spotlight on Foetal Alcohol Spectrum Disorder

30 May 2018

Minister for Health, Natasha Fyles, today welcomed 180 delegates to the inaugural Top End Foetal Alcohol Spectrum Disorder Forum in Darwin.

“Territorians want and deserve access to high quality health services,” Ms Fyles said.

“Alcohol abuse impacts on individuals, families, businesses and our community in many different ways, including the risk of causing permanent and irreversible damage to a baby if alcohol is consumed during pregnancy.

“That’s why reducing alcohol related harm is a key priority of the Territory Labor Government.

“Our Government will develop a whole of government framework to prevent FASD with universal and targeted strategies to address FASD.

“This strategy was supported by recommendations in the recent Riley Review into Alcohol Policy and Legislation Alcohol Report and is now an important part of the Territory Labor Government’s Alcohol Harm Minimisation Action Plan to deliver sweeping alcohol reforms for generational change.”

The NT Department of Health funded the Aboriginal Peak Organisations NT (APONT) to deliver the 2 day forum.

The themes of the Forum are:

  • Increase knowledge and raise awareness about FASD in Top End communities and the impact of alcohol during pregnancy on the developing baby;
  • Understand the impact of FASD on children, youth and their families
  • Identify the challenges, issues and solutions for governments, service providers and other key stakeholders;
  • Identify culturally appropriate resources, tools and protocols
  • Establish a Top End FASD Network.

Minister Fyles said that Forum provides an important consultation opportunity with the health sector and community to feed into the development of the NT’s FASD Strategy, for release later this year.

“Stories will be shared and ideas and actions generated to inform the Strategy, which in turn will help guide communities and Government to work together in partnerships to prevent FASD,” Ms Fyles said.

“The NT FASD Strategy will promote the screening of alcohol use before and during pregnancy; appropriate multi-disciplinary assessment; early intervention, support and case management; and will develop targeted education campaigns for those who are most at risk from alcohol-related harms.

“This work is supported in our Government’s 10-Year Early Childhood Development Plan to lead cultural change in reducing alcohol consumption and harms in the community.

“Our whole of government approach to respond to FASD will be crucial to preventing this completely preventable lifelong and permanent condition.”

 

NACCHO Aboriginal Health and #Alcohol : @healthgovau National Alcohol strategy 2018-2026 for public consultation Closes 11 February 2018

” The National Alcohol Strategy 2018- 2026 outlines Australia’s agreed approach to preventing and minimising alcohol-related harms.

The National Alcohol Strategy provides a national framework and highlights a number of opportunities for action under each of the priority areas of focus.

These opportunities are examples of activities or initiatives that could be considered at either local, jurisdictional (state and territory) or national levels, including a mix of broad population approaches and targeted approaches.”

Download a draft copy

Consultation Draft National Alcohol Strategy 2018-2026

Consultation closes 11 February 2018

The Department of Health has opened a public consultation process, and is inviting stakeholders and the general public to provide feedback on the National alcohol strategy 2018-2026.

See Website

As a sub-strategy of the National drug strategy 2017-2026, the National alcohol strategy is overseen by the Ministerial Drug and Alcohol Forum. The Forum consists of Ministers from across Australia with responsibility for alcohol and other drug policy  from the health and justice/law enforcement portfolios from each jurisdiction.

On 27 November 2017, members agreed that the draft National alcohol strategy will undergo a public consultation process to further inform the strategic direction and priorities of the strategy.

The online submission process is now open and will close on 11 February 2018. Feedback from the consultation will be considered by the Ministers at their next meeting in 2018, and the strategy revised.

To lodge a submission, please email nationaldrugstrategy@health.gov.au.

Disproportionate Impacts of Alcohol-Related Harm

This Strategy recognises that alcohol-related harms are not experienced uniformly across the population, with disproportionate levels of harm being experienced within some contexts and communities.

Read over 190 NACCHO Articles Alcohol and other Drugs posted over the past 5 years

Aboriginal and Torres Strait Islander people

Overall, Aboriginal and Torres Strait Islander people are more likely to abstain from drinking alcohol than non-Aboriginal and Torres Strait Islander people (31% compared with 23% respectively). However, among those who did drink, higher proportions drank at risky levels (20% exceeding the lifetime risk guidelines) and were more likely to experience alcohol-related injury than non-Aboriginal and Torres Strait Islander people (35% compared to 25% monthly, respectively).26

For this reason, Aboriginal and Torres Strait Islander people suffer from disproportionate levels of harm from alcohol, including alcohol-related mortality rates that are 4.9 times higher than among non-Aboriginal and Torres Strait Islander people.27

The poorer overall health, social and emotional wellbeing of Aboriginal and Torres Islander people than non-Aboriginal and Torres Strait Islander people are also significant factors which can influence drinking behaviours.28

People in remote areas

People residing in remote areas have reported drinking alcohol in quantities that place them at risk of harm at higher levels that those living in less remote regions.

People in remote and very remote areas were 1.5 times as likely as people in major cities to consume 5 or more drinks at least monthly and 2.4 times as likely to consume 11 or more drinks

Pregnant women (or those planning a pregnancy)

Alcohol consumption during pregnancy can result in birth defects and behavioural and neurodevelopmental abnormalities including Fetal Alcohol Spectrum Disorder (FASD). Data from states and territories have estimated FASD rates at 0.01 to 1.7 per 1000 births in the total population and 0.15 to 4.70 per 1000 births for the Aboriginal and Torres Strait Islander population.31 There is evidence that indicates some communities are experiencing much higher incidences of FASD and therefore the lifelong impacts of FASD.32

The relationship between the consumption of alcohol during pregnancy and the expression of FASD is complex, but avoiding drinking before or during pregnancy eliminates the risk of FASD.

Around 1 in 2 women report consuming alcohol during their pregnancy, with 1 in 4 women continuing to drink after they are aware they are pregnant. Of these women, 81% drank monthly or less with 16.2% drinking 2–4 times a month.33

Background

The Ministerial Drug and Alcohol Forum is co-Chaired by the Commonwealth Ministers with portfolio responsibility for alcohol and other drugs (AOD), and justice/law enforcement.

Membership consists of two Ministers from each jurisdiction, one each from the health/community services portfolios (with AOD policy responsibilities) and one from the justice/law enforcement portfolios.

The Commonwealth, State and Territory governments have a shared responsibility to build safe and healthy communities through the collaborative delivery and implementation of national strategic frameworks to reduce AOD related harms for all Australians.

The Forum will be supported by the National Drug Strategy Committee (NDSC) in the implementation and monitoring of these national strategic frameworks.

 

NACCHO Aboriginal Health and #Alcohol : New review explores the harmful effects of alcohol use in the Aboriginal and Torres Strait Islander context

 ” The review highlights that alcohol use among Aboriginal and Torres Strait Islander people needs to be understood within the social and historical context of colonisation, dispossession of land and culture, and economic exclusion.

While Aboriginal and Torres Strait Islander people are around 1.3 times more likely to abstain from alcohol than non-Indigenous people, those who do drink alcohol are more likely to experience health-related harms than their non-Indigenous counterparts.

 Furthermore, the evidence presented in this review suggests that effective strategies to address the problem of harmful alcohol use include: alternative activities, brief interventions, treatment and ongoing care; taxation and price controls and other restrictions on availability; and community patrols and sobering up shelters “

The Australian Indigenous Alcohol and Other Drugs Knowledge Centre (Knowledge Centre) has published a new Review of the harmful use of alcohol among Aboriginal and Torres Strait Islander people.

Read over 188 NACCHO Aboriginal Health and Alcohol Articles published over the past 5 years

https://nacchocommunique.com/category/alcohol-and-other-drugs/

The review explores the harmful effects of alcohol use in the Aboriginal and Torres Strait Islander context examining: patterns of use; health impacts; underlying causal factors; policies and interventions to address these impacts; and ways to further reduce harm.

View in Full Here

This review will help to inform, support and educate those working in Aboriginal and Torres Strait Islander health in Australia.

Ah 99

Key facts

The Australian context

  • Harmful use of alcohol is a problem for the Australian community as a whole. It is estimated that in 2011, alcohol caused 5.1% of the total burden of disease in Australia.
  • The social cost of all drug use in Australia in 2004–05 was estimated at $55.2 billion ($79.9 billion in 2016 dollars), with alcohol alone contributing 27.3%, and alcohol combined with illicit drugs adding a further 1.9%.

Extent of alcohol use among Aboriginal and Torres Strait Islander people

  • Alcohol use among Aboriginal and Torres Strait Islander people needs to be understood within the social and historical context of colonisation, dispossession of land and culture, and economic exclusion.
  • Aboriginal and Torres Strait Islander people are about 1.3 times more likely to abstain from alcohol than non-Indigenous people.
  • Aboriginal and Torres Strait Islander people are at least 1.2 and 1.3 times more likely to consume alcohol at levels that pose risks to their health over their lifetimes and on single drinking occasions than non-Indigenous people.
  • Aboriginal and Torres Strait Islander men are more than twice as likely as Aboriginal and Torres Strait Islander women to consume alcohol at risky levels.

Health impacts of alcohol use among Aboriginal and Torres Strait Islander people

  • Excessive alcohol consumption poses a range of health risks – both on single drinking occasions and over a person’s lifetime, including alcoholic liver disease, behavioural disorders, assault, suicide and transport accidents.
  • In NSW, Qld, WA, SA and the NT from 2010–2014 Aboriginal and Torres Strait Islander males and females died from conditions solely caused by alcohol more frequently than non-Indigenous males and females (4.7 and 6.1 times respectively).
  • The overall rate of suicide among Aboriginal and Torres Strait Islander people in 2015 was 2.1 times higher than among non-Indigenous people. For the period 2011–2015, 40% of male suicides and 30% of female suicides were attributable to alcohol use.
  • There is strong qualitative evidence linking alcohol and other drug (AOD) use and poor mental health among Aboriginal and Torres Strait Islander people.
  • Age standardised rates of hospitalisation for Aboriginal and Torres Strait Islander people in the years 2012–13, 2013–14 and 2014-15 were 2.7, 2.3 and 2.4 times those of non-Indigenous people.
  • In 2011, alcohol accounted for an estimated 8.3% of the overall burden of disease among Aboriginal and Torres Strait Islander Australians; a rate 2.3 times higher than among non-Indigenous people.
  • In addition to harms to health, high levels of alcohol use can contribute to a range of social harms, including child neglect and abuse, interpersonal violence, homicide, and other crimes.

Policies and strategies

  • Initial responses to the concerns about harmful alcohol use among Aboriginal and Torres Strait Islander people in the 1970s were driven not by governments but by Aboriginal and Torres Strait Islander people themselves who recognised that non-Indigenous mainstream responses were non-existent or largely culturally inappropriate.
  • The level of harm caused by alcohol in any community is a function of complex inter-relationships between the availability of alcohol, and levels of individual wellbeing and social conditions that either protect against or predispose people or groups to harmful levels of consumption.
  • As well as addressing the consequences of harmful levels of alcohol consumption, policies and intervention strategies must also address the underlying causal relationships. In the case of Aboriginal and Torres Strait Islander people this means addressing social inequality.
  • As part of the current Australian Government’s Indigenous advancement strategy (IAS), a number of programs are in place that aim to address social inequality and the broad social determinants of harmful alcohol use.
  • Government policy documents most directly relevant to the minimisation of alcohol-related harm among Aboriginal and Torres Strait Islander people are the National drug strategy 2017–2026 (NDS) and the National Aboriginal and Torres Strait Islander peoples’ drug strategy 2014–2019 (NATSIPDS).
  • The National drug strategy 2017–2026 provides a tripartite approach to reducing the demand for and supply of alcohol, and the immediate harms its causes.
  • There is a strong evidence base for the effectiveness of a range of interventions including: alternative activities, brief interventions, treatment and ongoing care; taxation and price controls and other restrictions on availability; and community patrols and sobering-up shelters.
  • Government programs to address Aboriginal and Torres Islander inequality have been in place since the 1970s – what is now the National Drug Strategy was introduced in 1985. While there have been some improvements, as evidenced by various Government reports, progress has been slow and while there have been increases in funding these have not been sufficient to meet need.
  • There is evidence that – provided with adequate resourcing – the culturally safe services provided by community-controlled organisations result in better outcomes. Aboriginal and Torres Strait Islander people should be key players in the design and implementation of interventions to address harmful alcohol use in their own communities, with capacity building within Aboriginal community-controlled organisations a central focus.
  • The way forward is for Australian Governments to honour the commitments made in the NATSIPDS to work with Aboriginal and Torres Strait Islander people and to resource interventions on the basis of need.

HealthInfoNet Director, Professor Neil Drew says ‘The latest review, written by Professor Dennis Gray and colleagues from the National Drug Research Institute (NDRI) in Western Australia, is a vital new addition to our suite of knowledge exchange resources.

It makes the large body of evidence available in a succinct, evidence-based summary prepared by world renowned experts.

This delivers considerable time savings to a time poor workforce striving to keep up to date in a world where the sheer weight of new information can often seem overwhelming.

I am delighted to release this important new resource to support the Aboriginal and Torres Strait Islander alcohol and other drug (AOD) sector.’

The review highlights that alcohol use among Aboriginal and Torres Strait Islander people needs to be understood within the social and historical context of colonisation, dispossession of land and culture, and economic exclusion.

While Aboriginal and Torres Strait Islander people are around 1.3 times more likely to abstain from alcohol than non-Indigenous people, those who do drink alcohol are more likely to experience health-related harms than their non-Indigenous counterparts.

Furthermore, the evidence presented in this review suggests that effective strategies to address the problem of harmful alcohol use include: alternative activities, brief interventions, treatment and ongoing care; taxation and price controls and other restrictions on availability; and community patrols and sobering up shelters.

http://aodknowledgecentre.net.au/aodkc/alcohol/reviews/alcohol-review

This review will help to inform, support and educate those working in Aboriginal and Torres Strait Islander health in Australia.

 

NACCHO Aboriginal Maternal Health Services News : Part 1.@AIHW releases Report : Part 2 .@HealthInfoNet Free #FASD Webinar 29 Nov

AMAT 

” The gap between the health of Aboriginal and Torres Strait Islander children and non-Indigenous children begins before birth, with babies born to Aboriginal and Torres Strait Islander mothers significantly more likely to have been exposed to tobacco smoke in utero, to be born pre-term, and to have a low birthweight (weighing less than 2,500 grams at birth) (AIHW 2015b).

These inequalities continue throughout early childhood for Aboriginal and Torres Strait Islander children, with higher mortality rates and higher rates of illness and poor health.

 This report presents the findings of a project which assessed Aboriginal and Torres Strait Islander women’s access to hospitals with public birthing services and 3 other types of maternal health services across Australia, then investigated possible high-level associations between access, maternal risk factors and birth outcomes.”

Download the report here

AIHW Indigenous Maternal Health .pdf

The findings of a project which assessed Aboriginal and Torres Strait Islander women’s access to hospitals with public birthing services and 3 other types of maternal health services across Australia,

Access to services

The study examined the geographic access of Indigenous women of child-bearing age (15–44) to 4 types of on-the-ground maternal health services: hospitals with a public birthing unit; Indigenous-specific primary health-care services (ISPHCSs); Royal Flying Doctor Service clinics; and general practitioners (GPs).

Using 1 hour drive time boundaries around these locations and population counts from the 2011 Census at a range of geographic levels (SA2, remoteness, jurisdiction), the study found:

  • approximately one-fifth (25,600 or 21%) of Indigenous women of child-bearing age lived outside a 1 hour drive time from the nearest hospital with a public birthing unit
  • nearly all (97%) Indigenous women of child-bearing age had access to at least 1 type of maternal health service within a 1 hour drive time. The lowest levels of access were for women in Very remote and Remote areas, where 84% and 93%, respectively, had access to at least 1 type of service.
  • Indigenous women of child-bearing age in Major cities, Inner regional and Outer regional areas had more types of services available to them within a 1 hour drive time than did women in more remote areas. Thus, they had more choice in which service they use

Association with area-level maternal risk factor and birth outcomes

Examining possible associations between geographic accessibility to services, maternal risk factors and birth outcomes at the Indigenous Region level, the study found that poorer access to:

  • GPs was associated with higher rates of pre-term birth and low birthweight
  • ISPHCSs with maternal/antenatal services was associated with higher rates of smoking and low birthweight
  • hospitals with public birthing units was associated with higher rates of smoking, pre-term birth and low birthweight
  • at least 1 service was associated with higher smoking rates and higher rates of pre-term delivery and low birthweight

An analysis at Primary Health Network (PHN) level found fewer significant associations, which is likely to be due to the PHNs’ size—particularly in jurisdictions with large Indigenous populations (such as the Northern Territory and Western Australia)—which may mask important intra-area variation.

This report was not able to take into account ISPHCSs which did not report to the Online Services Report collection, including state or territory maternal health services, outreach services, and antenatal/postnatal clinics conducted from hospitals which do not have birthing units.

It also focused on spatial accessibility and did not take into account other aspects of maternal health services such as cultural competency. Future analyses could incorporate other indicators or measures of access, maternal risk factors and birth outcomes.

1.Introduction

The gap between the health of Aboriginal and Torres Strait Islander children and non-Indigenous children begins before birth, with babies born to Aboriginal and Torres Strait Islander mothers significantly more likely to have been exposed to tobacco smoke in utero, to be born pre-term, and to have a low birthweight (weighing less than 2,500 grams at birth) (AIHW 2015b).

These inequalities continue throughout early childhood for Aboriginal and Torres Strait Islander children, with higher mortality rates and higher rates of illness and poor health.

The factors that contribute to poor infant and child health are complex and include maternal health (maternal weight, pre-existing health conditions); maternal risk factors (smoking and alcohol consumption during pregnancy, maternal nutrition); maternal age; social determinants (socioeconomic position and education); cultural determinants; and access to health services (such as antenatal care and child health services).

While access to health services will not eliminate the health gap between Indigenous and non-Indigenous babies and young children on their own, services have an important role to play in ameliorating the effects of the other factors listed above.

This report focuses on Aboriginal and Torres Strait Islander women’s geographic access to public birthing units and maternal health services, in order to identify areas with potential gaps in these services.

The report then examines whether there is an association between accessibility to services, maternal risk factors during pregnancy, and birth outcomes. It builds on a series of analyses the AIHW has been undertaking which are aimed at identifying geographic areas with potential gaps in services for Aboriginal and Torres Strait Islander Australians (AIHW 2014a, 2015c).

Background

Fetal health and development represents an intersection between physiological processes and the greater social context and environment. Inequalities in infant health outcomes are not randomly distributed throughout society, but are a reflection of broader social, environmental, historical, economic and cultural conditions (known as the ‘social determinants’ of health).

Figure 1.1 provides a conceptual overview of these processes, illustrating how these higher-level factors (‘distal’ determinants) affect contextual factors and individual mothers’ resources (intermediate factors)—which, in turn, affect ‘proximal’ determinants of both maternal health and maternal risk factors. These proximal determinants are those which then have a direct effect on fetal development.

Distal determinants (such as the long-term effects of colonisation and its effect on factors such as self-determination, the disruption of ties to land), and the adverse impact of racism, have all had an effect on Aboriginal and Torres Strait Islander people’s socioeconomic and psychosocial well-being (Osborne et al. 2013; Reading & Wein 2009).

Compared with non-Indigenous mothers, Aboriginal and Torres Strait Islander women have higher rates of the factors associated with poor infant health outcomes: on average, they have poorer socioeconomic status, lower levels of education, higher levels of psychosocial distress, are more likely to live in poor housing and are more likely to live in areas with fewer health services (intermediate determinants).

These intermediate determinants affect the proximal determinants of maternal health and maternal risk factors during pregnancy, which then have physiological effects on fetal health and development and increase the likelihood of pre-term birth. Available data show that Indigenous mothers have higher rates of a variety of health risks: they are 1.6 times as likely to be obese as non-Indigenous mothers and to have higher rates of pre-existing hypertension and pre-existing diabetes (which are linked with poorer birth outcomes) (AIHW 2016).

One of the strongest behavioural risk factors for poor birth outcomes and subsequent infant mortality and child mortality is smoking. Maternal smoking during pregnancy has been linked with intrauterine growth restriction (IUGR), poor lung development, stillbirth, pre-term birth, and placenta abruption. IUGR and low birthweight can increase the risk of poor perinatal outcomes such as necrotising enterocolitis and respiratory distress syndrome, and have long-term effects such as increased risks for short stature, cognitive delay, cerebral palsy, and poor cardiovascular health (Reeves & Bernstein 2008). Babies born to mothers who smoke during and after pregnancy are also more likely to die from Sudden Infant Death Syndrome.

AIHW multivariate analyses of perinatal data for the period 2012–2014 indicates that, excluding pre-term and multiple births, 51% of low birthweight births to Indigenous mothers were attributable to smoking, compared with 16% for non-Indigenous mothers (AIHW 2017). Evidence suggests that maternal exposure to second-hand smoke reduces birthweight as well.

While rates of smoking during pregnancy have decreased, data from 2013 show that 47.3% of Indigenous mothers smoked during pregnancy, compared with 10% of non-Indigenous mothers (AIHW 2016). The likelihood of smoking is not randomly distributed throughout society, but is related to the intermediate and proximal determinants shown in Figure 1.1.

Role of services

Figure 1.1 positions antenatal care/birthing services as mediating factors that can ameliorate the effects of distal, intermediate and proximate determinants, by working in partnership with Aboriginal and Torres Strait Islander mothers to ensure they have the knowledge, medical care, practical support and social support they require to improve their chances of having a healthy baby.

For example, early access to care can improve infant health through promoting positive change (such as reducing or stopping smoking), and identifying physiological risk factors which may require more specialised management (AIHW 2014b). High-quality, evidence-based and culturally competent (refer to Box 1.1) maternal and child health services, working in partnership with pregnant Aboriginal and Torres women, can help improve maternal and birth outcomes.

Women’s use of antenatal care services is affected by a number of factors, however, such as the availability and the financial and cultural accessibility of services as described above, as well as maternal factors such as early recognition of pregnancy and the perceived value attached to antenatal care (Kruske 2011; Pagnini & Reichman 2000).

Previous work has shown that, while nearly all Aboriginal and Torres Strait Islander mothers access antenatal care prior to giving birth, they are less likely than non-Indigenous mothers to access care early in the pregnancy (51% of Indigenous mothers attend an antenatal visit in the first trimester, compared with 62% of non-Indigenous mothers).

Spatial variation in Aboriginal and Torres Strait Islander women’s access to maternal health services 3

Box 1.1: Culturally competent maternal and child health services

Culturally competent antenatal care services are those in which woman-centred care is provided in ways that are respectful, understanding of local culture, and meet the emotional, cultural, practical and clinical needs of the women.

There are a number of aspects which characterise culturally competent maternal care services, some of which include having Indigenous-specific programs, having Aboriginal and Torres Strait Islander staff members, providing continuity of care, viewing women as partners in their care, having a welcoming physical environment, and ensuring that cultural awareness and safety is the responsibility of all staff members in the service (Kruske 2011).

Part 2 Prevalence of FASD Among Youth Under the Care of Juvenile Justice in Western Australia: How Shall We Work Together to Close this Gap? [webinar]

The Australian Indigenous Alcohol and Other Drugs Knowledge Centre (the Knowledge Centre) is hosting a Fetal alcohol spectrum disorder (FASD) webinar on Wednesday 29 November with guest presenter Dr Raewyn Mutch from the Telethon Kids Institute.

The theme for the webinar is Prevalence of FASD among youth under the care of Juvenile Justice in Western Australia: how shall we work together to close this gap? The webinar will run for approximately one hour, and will discuss a recent program that investigates FASD and the criminal justice system.

Dr Mutch is a Consultant Paediatrician, and works with Refugee Health at the Department of General Paediatrics, Princess Margaret Hospital for Children, as well as the Alcohol, Pregnancy and FASD department at Telethon Kids Institute. In addition, Dr Mutch also works as a Clinical Associate Professor at the School of Medicine, Dentistry and Health Sciences at the University of Western Australia.

The webinar will be free to attend, but you will need a browser with the latest version of Flash, and a stable internet connection. We’d recommend that participants use a pair of headphones, rather than their computer’s sound, as the sound quality will be better.

The webinar will be held at:

  • 1pm AEDT (NSW, Vic, Tas, ACT)
  • 12.30pm ACDT (SA)
  • 12pm AEST (Qld)
  • 11:30am ACST (NT)
  • 10am AWST (WA).

To attend the webinar, please click on this link about five minutes before it’s due to commence. If you have any queries about the webinar please refer to the contact details below.

Contacts

Millie Harford-Mills
Research Officer
Australian Indigenous HealthInfoNet
Ph: (08) 9370 6358
Email:

 

NACCHO Aboriginal Women’s Health #FASD Workshop dates : Development of the National #FASD Strategy 2018 – 2028

The Australian Government Department of Health is undertaking consultations to inform the development of the National FASD Strategy 2018– 2028.

The Strategy will provide a national approach for all levels of government, organisations and individuals on strategies that target the reduction of alcohol related harms relating to FASD, reducing the prevalence of FASD in Australia and provide advice and linkages on the support which is available for those affected by the disorder.

The objectives of the National FASD Strategy 2018 – 2028 are:

  • strengthen efforts and address the whole-of-life impacts of FASD;
  • address the whole-of-population issues;
  • support collaborative cross sectoral approaches required to prevent FASD in Australia; and
  • provide information and support those living with and affected by the disorder.

The Department has engaged Siggins Miller Consultants Pty Ltd (Siggins Miller) to undertake the development of the National FASD Strategywhich includes consultation with stakeholders and the development of a national strategy which provides a national holistic approach to reducing the prevalence of FASD; support Australians living with the disorder; guide the activities of individuals and communities as well as all levels of government, the public and research sectors, Not-For-Profit organisations which can adapted and implemented across Australia.

Siggins Miller is an experienced Australian consultancy company providing services for over 20 years in policy and program research, evaluation and management consultancy. The Siggins Miller project team is led by Professor Mel Miller (Director) and Mr James Miller (Senior Consultant).

As part of the consultation process, Siggins Miller will be conducting face-to-face strategy development workshops. There will also be other opportunities to provide feedback including through supplementary telephone interviews and written submissions.

The consultation period will run from 1st July, 2017 and conclude on the 1st September, 2017.

The workshops will be attended by with individuals and organisations working on FASD, individuals and organisations working with people affected by FASD, public health organisations and representatives of State and Territory Departments including: Health, Corrections and Juvenile Justice and Education and National Aboriginal Community Controlled Health Organisation (NACCHO) Affiliates.

The workshops will be catered and run from 9:30am – 3:30pm. Face-to-face strategy development workshops will be held in and on:

Sydney: Tuesday, August 1, 2017.

Canberra: Thursday August 3, 2017.

Melbourne: Tuesday,August 8, 2017.

Hobart: Thursday, August 10, 2017.

Brisbane: Tuesday,August 15, 2017.

Cairns: Thursday, August 17, 2017.

Perth: Tuesday,August 22, 2017.

Broome: Thursday, August 24, 2017.

Darwin: Tuesday,August 29, 2017.

Alice Springs: Thursday, August 31, 2017.

Adelaide: Monday, September 4, 2017.

Exact addresses of venues are in the process of being finalised and will be communicated to all stakeholder by Siggins Miller in the coming weeks.

It should be noted that due to capacity of venues, spaces to attend the face-to-face strategy development workshops are limited in each location. Invited participants will also be responsible for any costs associated with attending the face-to-face workshop in each location.

Siggins Miller will be in contact with you by email in the coming weeks with an invitation for you to attend one of the face-to face strategy development workshops.

In the meantime, should you have any questionsabout the consultation and written submission process, please contact Siggins Millerby email on fasdstrategy@sigginsmiller.com.au or by phone on: 1800 055 070.

Please note that the 1800 number provided is a message bank service in which you can leave your inquiry, a senior Siggins Miller staff member will endeavour to return your call within 72 hours.

 

 

NACCHO Aboriginal Health and #FASD : #Prevention and #HealthPromotion Resources Package

 ” The Fetal Alcohol Spectrum Disorder (FASD) Prevention and Health Promotion Resources Package – ‘the Package’

 Is designed to equip Australian health professionals with the knowledge and skills needed to develop, implement and evaluate community-driven solutions to reduce alcohol consumption, tobacco smoking and substance misuse during pregnancy, and to cut down on the number of unplanned pregnancies in their communities.

During 2015–17, the Package was delivered to staff from participating New Directions: Mothers and Babies Services (NDMBS), a national program to increase access to child and maternal health care for Aboriginal and Torres Strait Islander families.”

Download the 4 Page brochure

FASD_Resources_Package_Summary

And read the 20+ FASD NACCHO articles published

Why are these resources needed?

Although high rates of alcohol consumption have been reported across all Australian populations, research shows that Aboriginal and Torres Strait Islander women are more likely to consume alcohol at harmful levels during pregnancy, thereby greatly increasing the risk of stillbirths, infant mortality and infants born with an intellectual disability.

Addressing the effects of alcohol consumption during pregnancy, and in particular FASD, requires both an understanding of how the cultural context, historical legacy and social determinants affect Aboriginal and Torres Strait Islander people, and the importance of working in partnership with communities and relevant organisations.

When surveyed, most health professionals reported they did not ask their clients about alcohol use in pregnancy, or provide women with information about the effects of alcohol on the fetus.2 Challenges included limited knowledge and resources among health professionals to tackle the issue, along with a lack of confidence in advising clients. As such, we determined that resourcing and educating health professionals were critical factors to implementing a whole-of-community approach to preventing FASD in Aboriginal and Torres Strait Islander communities.

Piloting the Package

We piloted two days of training with 80 health professionals from 40 participating NDMBS sites, with the aim of increasing:

  1. awareness and understanding of alcohol, tobacco and other substances use during pregnancy and of FASD
  2. awareness of existing FASD health promotion resources and of how best to use these resources within primary health care services in line with their community needs
  3. knowledge and skills to develop, implement and evaluate community-driven solutions to reduce alcohol consumption, tobacco smoking and substance misuse during pregnancy, and reduce unplanned pregnancies

What’s in the Package?

Health promotion resources targeted at five key groups:

  1. Pregnant women
  2. Women of child-bearing age
  3. Grandmothers and aunties
  4. Men
  5. Health professionals

Five discrete training modules to assist health professionals share FASD prevention information and use the resources effectively within their community:

  • Introduction: FASD Prevention and Health Promotion Resources Package
  • Module 1: What is Fetal Alcohol Spectrum Disorder?
  • Module 2: Brief Intervention and Motivational Interviewing
  • Module 3: Monitoring and Evaluation
  • Module 4: Sharing Health Information

Training support materials to assist health professionals in delivering their own FASD training:

  • Facilitator manual
  • Participant workbook

Download the 4 Page brochure

FASD_Resources_Package_Summary

For more information

Dr Christine Hannah  07 3169 4201

christine.hannah@menzies.edu.au

 

NACCHO #IWD2017 Aboriginal Women’s #justjustice :Indigenous, disabled, imprisoned – the forgotten women of #IWD2017

 

” Merri’s story is not uncommon. Studies show that women with physical, sensory, intellectual, or psychosocial disabilities (mental health conditions) experience higher rates of domestic and sexual violence and abuse than other women.

More than 70 per cent of women with disabilities in Australia have experienced sexual violence, and they are 40 per cent more likely to face domestic violence than other women.

Indigenous women are 35 times more likely to be hospitalised as a result of domestic violence than non-Indigenous women. Indigenous women who have a disability face intersecting forms of discrimination because of their gender, disability, and ethnicity that leave them at even greater risk of experiencing violence — and of being involved in violence and imprisoned

Kriti Sharma is a disability rights researcher for Human Rights Watch

This is our last NACCHO post supporting  International Women’s Day

Further NACCHO reading

Women’s Health ( 275 articles )  or Just Justice  See campaign details below

” In-prison programs fail to address the disadvantage that many Aboriginal and Torres Strait Islander prisoners face, such as addiction, intergenerational and historical traumas, grief and loss. Programs have long waiting lists, and exclude those who spend many months on remand or serve short sentences – as Aboriginal and Torres Strait Islander people often do.

Instead, evidence shows that prison worsens mental health and wellbeing, damages relationships and families, and generates stigma which reduces employment and housing opportunities .

To prevent post-release deaths, diversion from prison to alcohol and drug rehabilitation is recommended, which has proven more cost-effective and beneficial than prison , International evidence also recommends preparing families for the post-prison release phase. ‘

Dying to be free: Where is the focus on the deaths occurring post-prison release? Article 1 Below

Article from Page 17 NACCHO Aboriginal Health Newspaper out Wednesday 16 November , 24 Page lift out Koori Mail : or download

naccho-newspaper-nov-2016 PDF file size 9 MB

As the world celebrates International Women’s Day, this week  I think of ‘Merri’, one of the most formidable and resilient women I have ever met.

A 50-year-old Aboriginal woman with a mental health condition, Merri grew up in a remote community in the Kimberley region of Western Australia. When I met her, Merri was in pre-trial detention in an Australian prison.

It was the first time she had been to prison and it was clear she was still reeling from trauma. But she was also defiant.

“Six months ago, I got sick of being bashed so I killed him,” she said. “I spent five years with him [my partner], being bashed. He gave me a freaking [sexually transmitted] disease. Now I have to suffer [in prison].”

I recently traveled through Western Australia, visiting prisons, and I heard story after story of Indigenous women with disabilities whose lives had been cycles of abuse and imprisonment, without effective help.

For many women who need help, support services are simply not available. They may be too far away, hard to find, or not culturally sensitive or accessible to women.

The result is that Australia’s prisons are disproportionately full of Indigenous women with disabilities, who are also more likely to be incarcerated for minor offenses.

For numerous women like Merri in many parts of the country, prisons have become a default accommodation and support option due to a dearth of appropriate community-based services. As with countless women with disabilities, Merri’s disability was not identified until she reached prison. She had not received any support services in the community.

Merri has single-handedly raised her children as well as her grandchildren, but without any support or access to mental health services, life in the community has been a struggle for her.

Strangely — and tragically — prison represented a respite for Merri. With eyes glistening with tears, she told me: “[Prison] is very stressful. But I’m finding it a break from a lot of stress outside.”

Today, on International Women’s Day, the Australian government should commit to making it a priority to meet the needs of women with disabilities who are at risk of violence and abuse.

In 2015, a Senate inquiry into the abuse people with disabilities face in institutional and residential settings revealed the extensive and diverse forms of abuse they face both in institutions and the community. The inquiry recommended that the government set up a Royal Commission to conduct a more comprehensive investigation into the neglect, violence, and abuse faced by people with disabilities across Australia.

The government has been unwilling to do so, citing the new National Disability Insurance Scheme (NDIS) Quality and Safeguard Framework as adequate.

While the framework is an important step forward, it would only reach people who are enrolled under the NDIS. Its complaints mechanism would not provide a comprehensive look at the diversity and scale of the violence people with disabilities experience, let alone at the ways in which various intersecting forms of discrimination affect people with disabilities.

The creation of a Royal Commission, on the other hand, could give voice to survivors of violence inside and outside the NDIS. It could direct a commission’s resources at a thorough investigation into the violence people with disabilities face in institutional and residential settings, as well as in the community.

The government urgently needs to hear directly from women like Merri about the challenges they face, and how the government can do better at helping them. Whether or not there is a Royal Commission, the government should consult women with disabilities, including Indigenous women, and their representative organizations to learn how to strengthen support services.

Government services that are gender and culturally appropriate, and accessible to women across the country, can curtail abuse and allow women with disabilities to live safe, independent lives in the community.

Kriti Sharma is a disability rights researcher for Human Rights Watch

 

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How you can support #JustJustice

• Download, read and share the 2nd edition – HERE.

Buy a hard copy from Gleebooks in Sydney (ask them to order more copies if they run out of stock).

• Send copies of the book to politicians, policy makers and other opinion leaders.

• Encourage journals and other relevant publications to review #JustJustice.

• Encourage your local library to order a copy, whether the free e-version or a hard copy from Gleebooks.

• Follow Guardian Australia’s project, Breaking the Cycle.

Readers may also be interested in these articles:

NACCHO Aboriginal Health and Fetal Alcohol Spectrum Disorders #FASD : Community participation is a key principle in effective health promotion

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 ” Community participation is a key principle in effective health promotion. Gurriny have used a whole-of-community approach by involving the five above mentioned target groups when designing their FASD prevention activities.

Gurriny consulted with women of childbearing age to learn about their views and attitudes towards alcohol, and assed their current knowledge about the harms associated with drinking in pregnancy. It was also important for health professionals to understand what types of alcoholic drinks women of child bearing age were consuming and how much.

For further information about the FASD Prevention and Health Promotion Resources Project please contact Bridie Kenna on 0401 815 228 or bridie.kenna@naccho.org.au

Read 17 Articles about FASD

Menzies School of Health Research have partnered with the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Telethon Kids Institute (TKI) to develop a package of resources to reduce the impacts of FASD on the Aboriginal population.

FASD is a diagnostic term used for a spectrum of conditions caused by fetal alcohol exposure. Each condition and its diagnosis is based on the presentation of characteristic features which are unique to the individual and may be physical, developmental and/or neurobehavioural.

The package of resources is based on the model developed by the Ord Valley Aboriginal Health Service (OVAHS). OVAHS is an Aboriginal Community Controlled Health Service located in the far north east region of the Kimberly in Western Australia. OVAHS services Aboriginal people in the remote town of Kununurra and surrounding regions.

The package incorporates FASD education modules targeting five key groups:

  • Pregnant women using New Directions: Mothers and Babies Services (NDMBS) antenatal services, and their partners and families;
  •  Aboriginal and Torres Strait Islander women of childbearing age;
  •  Aboriginal and Torres Strait Islander grandmothers;
  •  NDMBS staff who provide antenatal care
  •  Aboriginal and Torres Strait Islander men.

To complement the package of resources, two day capacity building workshops for the 85 New Directions: Mothers and Babies Services (NDMBS) were held in Darwin, Cairns, Melbourne (TAS, VIC and SA sites combined), Perth and Sydney. The aim of the training workshops was to enable NDMBS sites to develop, implement and evaluate community-driven strategies and solutions by:

i. Increasing awareness and understanding of alcohol use during pregnancy, and FASD;

ii. Increasing awareness and understanding of existing FASD health promotion resources;

iii. Increase understanding, skills and capacity to use existing FASD health promotion resources within NDMBS, in line with their capacity, readiness and community circumstances and needs.

Staff from Gurriny Yealamucka Health Service (Gurriny) participated in the Queensland FASD training workshop in April. Since then, Gurriny have thrived in the area of FASD prevention by implementing multiple strategies within their community.

A key component of the FASD training workshop was highlighting the importance of routine screening of women about alcohol use during pregnancy. Assessment of alcohol consumption, combined with education in a supportive environment can assist women to stop or significantly reduce their alcohol use during pregnancy. A number of screening tools were introduced at the workshop including AUDIT-C (Alcohol Use Disorders Identification Test – Consumption), which Gurriny have now incorporated into their own data recording system. This tool has three short questions that estimate alcohol consumption in a standard, meaningful and non-judgemental manner.

Gurriny now places great emphasis on providing routine screening of women about their alcohol use during all stages of pregnancy and recording results in clinical records at each visit. Health professionals at Gurriny often use brief intervention and motivational interviewing techniques to guide conversations about alcohol and pregnancy.

This is of particular significance when working with pregnant women, as there are multiple opportunities through routine antenatal care to provide support through the stages of change. There is sound evidence that motivational interviewing and brief interventions can decrease alcohol and other drug use in adults. Both practices are listed in the Royal Australian College of General Practice (RACGP) guidelines as an effective strategy for positive behaviour change.

It is estimated that over half of all pregnancies in Australia are unplanned and many Australian women are unknowingly consuming alcohol during pregnancy. Providing women of childbearing age with reliable information about the risks of alcohol consumption during pregnancy and the importance of contraception use if they are not planning a pregnancy are essential strategies in preventing FASD. Staff at Gurriny have pre-conception discussions about healthy pregnancies and FASD prevention with women who cease contraception use and may be planning a pregnancy. Women are provided with reliable information in a supportive environment to help them make informed decisions.

Knowledge transfer strategies are a key component to ensure new information is shared and retained within the service and community. Members from Gurriny’s Child and Maternal Health team have shared the package of resources and new skills gained at the workshop with a number of their colleagues, both clinical and administrative. They have also shared the new information with relevant health professionals from external organisations, including the local hospital. This assists in developing a more consistent approach to FASD prevention and maximises available resources in the community. Gurriny have made links with other health and community services within the Yarrabah community to develop a coordinated, strategic approach to FASD prevention.

Community participation is a key principle in effective health promotion. Gurriny have used a whole-of-community approach by involving the five abovementioned target groups when designing their FASD prevention activities.

Gurriny consulted with women of childbearing age to learn about their views and attitudes towards alcohol, and assed their current knowledge about the harms associated with drinking in pregnancy. It was also important for health professionals to understand what types of alcoholic drinks women of child bearing age were consuming and how much.

Based on the findings, laminated cards were developed which show the number of standard drinks in each serving according to the National Health and Medical Research Council (NHMRC) alcohol guidelines. These cards are used in both one-on-one and group based education sessions. There is no safe level of alcohol consumption at any stage of pregnancy; this message is emphasised at all opportunities with women of childbearing age.

Raising community awareness is a key strategy in successful health promotion. Gurriny have a strong presence in the Yarrabah community and often attend health and community events to raise awareness of the harms associated with drinking in pregnancy and FASD.

Health staff make use of any opportunity to raise awareness, share information and prompt people to think about making positive changes to their own drinking behaviour, or support others to do so.

Additional awareness raising strategies include showing FASD prevention DVD’s on iPad’s in clinic waiting rooms, demonstrating the concept of the invisible nature of FASD disability by using demonstration FASD dolls in education sessions, and having posters about healthy pregnancies and FASD prevention in clear view throughout the clinic.

Health promotion is most effective when multiple strategies are used which target not only the individual, but the community at large. It is evident Gurriny Yealamucka Health Service is using this approach in order to reach the best possible health outcomes for women, children and families.

For further information about the FASD Prevention and Health Promotion Resources Project please contact Bridie Kenna on 0401 815 228 or bridie.kenna@naccho.org.au

 

NACCHO Aboriginal Health and #FASD : Record Indigenous incarceration #justjustice rates could be avoided with early clinical assessment: experts

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 “Australia’s prison population recently reached a record 33,791 with 27 per cent of those identifying as Aboriginal or Torres Strait Islanders

Leading experts in Fetal Alcohol Spectrum Disorder (FASD) believe Australia’s record rates of Indigenous incarceration could be dramatically reduced if children were clinically assessed when their troubled behaviour first emerged in the classroom or at home.

In one form or another, Federal, State and Territory Governments have been inquiring into Indigenous prison rates since the 1987 leaving behind a long list of mostly-ignored recommendations “

As reported by Russell Skelton ABC

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NACCHO partnered with the Menzies School of Health Research and the Telethon Kids Institute (TKI) to develop and implement health promotion resources and interventions to prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD) on Aboriginal and Torres Strait Islander families and young children.

NACCHO Report 1 of 4 :Prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD)

Key points:

  • Experts say Indigenous incarceration rates could be reduced with early behavioural assessment
  • Fetal Alcohol Spectrum Disorder (FASD) affects many of those incarcerated
  • People with FASD are often unable to instruct a lawyer, understand court procedures and even the decisions handed down when convicted

The facts about FASD

  • FASD covers a range of conditions that can occur in children whose mothers drink during pregnancy
  • Conditions vary from mild to severe
  • The effects can include learning difficulties, behavourial problems, growth defects and facial abnormalities
  • The Australian Drug Foundation believes the condition is “significantly under-reported” in Australia
  • National Health and Medical Research Council guidelines say not drinking at all all during pregnancy is the safest option

A major issue in recent months:

  • Last month the Northern Territory’s adult prison population hit an alarming 15-year high. According to Corrections Commissioner Mark Payne 958 people are being held — almost half aboriginal and Torres Strait Islanders. He expects half will reoffend within two years of being released.
  • A report by Amnesty International Australia found, and ABC Fact Check confirmed, that incarceration rates for Indigenous children were 24 times higher than they were for non-Indigenous children.In WA the rate is 76 per 10,000, in the US, where rates of black incarceration are regarded as the highest in the western world, it is 52.
  • Attorney-General George Brandis and the Indigenous Affairs Minister Nigel Scullion announced the Federal Government have commissioned the Australian Law Reform Commission to investigate factors behind the over representation of Indigenous Australians in prison and to recommend reforms to “ameliorate the national tragedy”.
  • The appointment of a Royal Commission to investigate brutal treatment and years of detainee abuse at Darwin’s Don Dale Youth detention facility.The move followed detailed allegations of mistreatment by the ABC’s Four Corner program.

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The #JustJustice book is was launched  at Gleebooks in Sydney yesterday by Professor Tom Calma AO, and NACCHO readers are invited to download the 242-page e-version

The Federal Government must make good on its promise to listen to, and work with, Aboriginal and Torres Strait Islander people, including engaging with the solutions put forward in the forthcoming #JustJustice essay collection.

The book includes more than 90 articles on solutions to protect the rights of Australia’s First Peoples.

The experts said parents, teachers and health workers were often well aware of unacceptable behaviour in young people — both Indigenous and non-Indigenous — long before they appeared before the courts.

Around 70 per cent of young people in the juvenile justice system are Aboriginal, and research shows rates of the disorder amongst Aboriginal communities are significantly higher than non-Aboriginal communities.

Elizabeth Elliot, professor of Paediatrics and Child Health a Sydney University, said: “What we need is screening tool so teachers and health workers can assess a child’s executive functions and red flag cognitive impairments early on before they encounter the justice system.”

Paediatrician and clinical research fellow at Perth’s Telethon Kids Institute Dr Raewyn Mutch agreed, saying there was a growing need to identify serious behavioural issues associated with FASD and other developmental disorders such as autism so affected children can be better managed.

Fetal Alcohol Spectrum Disorder, known as FASD, occurs in the children whose mothers consumed alcohol during pregnancy.

Symptoms include lifelong physical, mental, behavioural and learning difficulties. It can cause severe intellectual impairment, learning and memory disorders, high-risk and violent behaviour.

Professor Elliott said reform in Australia had been “glacial” compared with Canada and the United States, as authorities have been slow to acknowledge the extent of the problem.

“In Canada it is estimated that 60 per cent of kids in the juvenile justice system are FASD, it is a huge number,” she said.

“We don’t need another inquiry into the justice system, we need governments to act on the evidence before them from past inquiries,

Professor Elliott was the paediatric specialist involved the ground-breaking Lililwan study initiated by Aboriginal women. The study that found that one in five Indigenous children living in WA Fitzroy River Valley had FASD. Although still teenagers, many were before the juvenile justice.

“For children suffering from FASD, it’s like having the umpire removed from an AFL match, they have difficulties deciding best choices or understanding cause and effect,” Dr Mutch said.

“A person with FASD may have cognitive impairment, language difficulties as severe as being illiterate.”

Professor Elliott, a widely acknowledged authority on FASD, said offenders — non-Indigenous and Indigenous — with fetal alcohol brain damage were often incapable of changing their behaviour and learning from mistakes.

“These are young people who can be easily led, are incapable of understanding the consequences of their actions, have difficulty understanding the boundaries for acceptable behaviour. They can confess to crimes they did not commit.”

Dr Mutch said not only FASD affected individuals ended up in the justice system, but children with developmental difficulties and also children traumatised by conflict and abuse.

She is involved in landmark study of young offenders in WA’s Banksia Hill Detention Centre to establish the prevalence of FASD and other neurological disorders. The study is likely to revolutionise strategies for handling juveniles with “neurodevelopmental” issues.

The study will establish the first authoritative estimate in Australia of FASD among young people in detention. It involves a two day multi-disciplined clinical assessment of children with the hope of developing a screening tool for application among all young people entering the juvenile justice system.

“Children in the juvenile justice system have ended up there for a variety of reasons, many of these kids have learning and memory problems,” Dr Mutch said.

“They may also have speech and language problems. Not all are FASD affected, but all I would predict have experienced severe trauma.”

A ‘national tragedy’

A Productivity Commission report into Indigenous disadvantage released last week confirmed rates of incarceration had failed to drop despite a string of reports, inquiries and recommendations dating back to 1987 Deaths in Custody Royal Commission.

Dr Mutch said children were being excluded from society because their behaviour.

“The central question is what are the factors that caused them to be like that and how best to rehabilitate them,” she said.

Both Professor Elliott and Dr Mutch believe screening and clinical assessments in childhood would identify cognitive problems, enable early treatment and result in profound improvements in troublesome behaviours.

This would have an impact on child protection placements including foster care and the management of group homes where evidence has emerged of inappropriate placements and poor supervision.

Offenders with FASD are easily led, coerced by their peers. They can be incapable of providing a record of events, names of associates and often confabulate even to the extent of making false confessions.

They are often unable to instruct a lawyer, understand court procedures and even the decisions handed down when convicted.

In one form or another, Federal, State and Territory Governments have been inquiring into Indigenous prison rates since the 1987 leaving behind a long list of mostly-ignored recommendations.

The Senate is also inquiring into the indefinite detention of people with cognitive impairments — a central issue when it comes to explaining the “national tragedy”.

The Telethon Kids Institute noted in a submission to Senate inquiry into the indefinite detention of people with cognitive and psychiatric impairment that diagnosis of FASD has been limited by a lack of knowledge and until recently an absence of accepted national diagnostic framework.

Australia’s prison population recently reached a record 33,791 with 27 per cent of those identifying as Aboriginal or Torres Strait Islanders.