Remote Australia Online

Introduction: More Aboriginal and Torres Strait Islander young people experience high or very high levels of psychological distress compared to their non-Indigenous counterparts. This may be partly attributed to systemic barriers resulting in lower rates of help-seeking, sub-optimal identification of psychological challenges, and undertreatment. Reducing these barriers within health systems is an important factor in reducing the Social and Emotional Wellbeing (SEWB) health burden on young Aboriginal and Torres Strait Islander people. Objectives: In partnership with Miwatj Health Aboriginal Corporation (Miwatj), this project will co-design an integrated youth Social and Emotional Wellbeing (SEWB) and mental health stepped care model for remote Aboriginal communities in the north east Arnhem region of the Northern Territory. Design: A collaborative research approach using co-design methods will underpin a community-centric stepped care allocation method, to which culturally appropriate SEWB and mental health interventions and treatments are assigned. These components of the project will inform a digital platform which will facilitate access to SEWB care for young people in north east Arnhem land. This concept was co-developed in a partnership between researchers and Miwatj and builds on Miwatj's previous work to map the stepped needs of young people. The co-design of the content and features of these outputs will be facilitated through community participation and overseen by community, health, and cultural governance structures. This will ensure the solutions developed by the project are culturally responsive, fit for purpose, and will enhance self-determination while reducing systemic barriers to care.

Objective: To share the findings of a service-based ‘healthy skin initiative’ implemented during an outbreak of Acute Post-Streptococcal Glomerulonephritis (APSGN) in the Kimberley. Methods: There were four consecutive visits to a remote Aboriginal community in the Kimberley over six months combining environmental health (EH), health promotion (HP) and public health (PH) alongside on-site primary health care (PHC). Activities and key findings were documented. Clinic data were independently retrieved from a de-identified administrative database to compare skin presentations to the PHC clinic before and after this initiative. Results: PH team achieved high rates of assessment of children aged 1-17 years, seeing 176 children (median age, 11 years) in total and completing 371 assessments. Forty-four comprehensive home health hardware assessments identified 242 repairs for referral (range per home assessment 1-15; median 5). Of these, all but one was completed within six months (<1%). Clinic data showed significant decrease before and after this initiative in presentations to the local clinic for scabies (9.5% v 2.2%) (p<0.0001). Conclusions: This service-based initiative adopted a partnership approach, respected community empowerment and demonstrated positive yields that the community has endorsed as a ‘good news story’. Implications: Achieving skin integrity for Aboriginal children requires genuine partnership between community leaders, PHC clinic staff, EH, HP and PH. This initiative, galvanised in an APSGN outbreak, required considerable planning and resource reallocation. These achievements invite consideration of long-term investment in community-based environmental health, health promotion and primary health care services beyond the outbreak itself.

It is generally accepted by researchers, policy-makers and practitioners that progress in Indigenous education depends on working in partnership with Indigenous people, and that programs and services are best provided in partnership. The 2014–2016 Whole of Community Engagement initiative built a partnership of non-Indigenous researchers with researchers, teachers, education leaders and elders from six remote Northern Territory Aboriginal communities. In this paper we describe the features that led us to characterise the initiative and the remote community and school context as intercultural and complex. The former included methodology, staffing, meeting procedure and interpersonal communication, negotiation of meaning and decision-making. On the basis of this approach, we found that intercultural complexity was strongly evident in schooling in Galiwin’ku, Elcho Island, North East Arnhem Land, which was the community most closely studied by the authors. The paper contributes to the recognition of intercultural complexity in remote Aboriginal schooling, and the potential benefit that its recognition can have for educational outcomes in those contexts.

Thirty years ago the first edition of the Australian Journal of Rural Health (AJRH) was published. Following reviews published in 2002 and 2012, it is again time to review what progress has been made in bringing about improved health outcomes for residents of rural and remote Australia over the past decade. Compounded by the Covid-19 crisis that has affected the health and health care system throughout Australia, this review notes the significant lack of progress over the past decade in ameliorating ongoing problems of poor access to primary health care and associated avoidable hospitalisations, persistent poor health of Indigenous Australians, and the greater prevalence of a range of health risk factors. Following the findings of the recent New South Wales enquiry into rural health, this review highlights what is needed to implement the many recommendations that have emerged from the wealth of evidence-based research published in journals such as the AJRH to improve health outcomes and increase the parity and equity in health between metropolitan and non-metropolitan Australians.

Where would we be without microbiology in tackling the high prevalence of otitis media (OM; middle ear infection) and disabling hearing loss that disadvantage Australian First Nations children living in remote communities? Understanding the microbiology of OM in this population has been critical in directing innovative clinical trials research and developing appropriate evidence-based practice guidelines. While these processes are critical to reducing disadvantage associated with OM and disabling hearing loss, a remaining seemingly insurmountable gap has remained, threatening progress in improving the lives of children with ear and hearing problems. That gap is created by the crisis in primary health care workforce in remote communities. Short stay health professionals and fly-in fly-out specialist services are under-resourced to manage the complex needs of the community, including prevention and treatment of otitis media and hearing loss rehabilitation. Hence the rationale for the Hearing for Learning Initiative – a workforce enhancement model to improve sustainability, cultural appropriateness, and effectiveness of evidence-based ear and hearing health care for young children in remote settings. This paper summarises the role of microbiology in the pathway to the Hearing for Learning Initiative.

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020-2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers? capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools? capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally.

Aboriginal education in remote areas of Australia continues to be a contested focus for policy and practice, with little debate that actively involves Aboriginal people themselves. This thesis attempts to redress this gap in a small way by in-depth conversations about education with Anangu in the tristate area of central Australia (the region where Western Australia, South Australia and the Northern Territory meet). Here Aboriginal people live in relatively small, dispersed desert communities with close language and familial connections. Contact with Europeans is relatively recent, with provision of schooling moving from centralised mission-based schooling to decentralised community schools following the 1967 referendum. Anangu children are frequently positioned as deficient in mainstream educational achievement narratives within colonial and neo- colonial educational endeavours. This study seeks to inform Anangu education policy and practice from Anangu standpoints and to explore the potential for standpoint dialogue in negotiating alternatives in tristate education (Harding, 1992). This thesis privileges Anangu standpoint accounts in relation to young people, education and the future. The series of interviews, held across several years and translated and presented with minimal editing, are predominantly held in local languages and demonstrate the priority of oral histories and stories as Indigenous genres for knowledge sharing. A textual standpoint dialogue is staged between Anangu participants and trusted Piranpa (non-Indigenous) education leaders whom Anangu participants identify, describing practice from the 1950s to the current day. Through investigation of a number of historical sources, the background to colonial contact and approaches to provision of education in the tristate area in the twentieth century is provided which correlates with the Anangu standpoints given in the series of interviews. Diverse histories and interactions with colonialism and education shape points of difference between and among Anangu (Pitjantjatjara/Yankunytjatjara/Ngaanyatjarra) standpoints (Nakata, 2007a). The Anangu stories reflect how colonial interests are privileged in the historical interactions with cattle stations (including the removal of children), the Maralinga bomb, centralisation of populations to mission centres and sporadic engagement with mining interests. This study found that deep conversations about education across Anangu and Piranpa standpoints have been difficult even where educators spoke local languages and developed close relationships with Anangu. Educators feel caught between professional imperatives for upward accountability and personal conviction of the need for reciprocal accountability to community priorities and demands. Significant points of epistemic differentiation between Western norms represented in educational policy and practices and Anangu lives underscore the importance of seeking venues for standpoint dialogue where Anangu voices are privileged in (re)shaping Anangu education provision. Implications for inducting educators into remote schools are also explored.

Achieving healthy skin requires the prevention of infectious diseases that affect the skin. Prevention activities range from environmental health improvements to address inequities in living situations, through to community-wide treatment programs to reduce transmission and improve skin health. In this paper we discuss the pathogens that cause and conditions that arise when skin is infected, the burden of disease in northern Australia, and some of the current research underway to address this high burden, which predominantly affects remote-living Aboriginal and Torres Strait Islander children and families.

This book gives voice to the direct practice experience of social workers working in rural and remote contexts using Australia as the primary case-study. The authors undertake a qualitative research project, conducting in-depth interviews to examine social work theory and practice against the reality of rural and remote contexts. Practice examples provide the reader with an insight into the diverse and complex nature of social work in rural and remote Australia and the role of contemporary social work. Through placing rural and remote social work in its historical, theoretical and geographical contexts, this work explores a range of considerations. These include isolation; ethical dilemmas when working with small and closely linked communities; climate, disaster relief and the environment; community identity and culture; working with indigenous communities in remote contexts; and social work education. Based on direct practice research, this book challenges existing theories of practice and reframes those to reflect the reality of practice in rural and remote communities. As social work must continue to critically reflect on its role within an ever changing and individualistic society, lessons from rural and remote settings around engagement, sense of place and skillful, innovative practice have never been more relevant.

OBJECTIVE: To present data on rotavirus notifications in the Northern Territory to provide knowledge about the local epidemiology of rotavirus gastroenteritis that can be used to inform the use and funding of rotavirus vaccines. DESIGN: Retrospective analysis of data from the Northern Territory Notifiable Diseases Database. PARTICIPANTS AND SETTING: Patients with cases of rotavirus infection notified to the NT Centre for Disease Control from 1 January 1995 to 31 December 2004. MAIN OUTCOME MEASURES: Patterns of rotavirus notifications over time; infection rates in Indigenous versus non-Indigenous children aged 0-5 years; age groups infected with rotavirus. RESULTS: Numbers of rotavirus notifications over the period 1995-2004 show annual, monthly and regional variability. The rotavirus notification rate for Indigenous children aged 0-5 years was 2.75 per 100 per year, compared with 0.98 for non-Indigenous children, with a relative risk for Indigenous children of 2.17 (95% CI, 1.97-2.39) over the 10 years. Indigenous children infected with rotavirus were younger than non-Indigenous children, with median ages of 11 months and 16 months, respectively. Rotavirus gastroenteritis occurred in outbreaks, transmitted over months throughout the NT. CONCLUSION: Large numbers of cases of rotavirus gastroenteritis affecting Indigenous and non-Indigenous children in the NT are notified every year. The rate in Indigenous children may be decreasing relative to non-Indigenous children. An effective rotavirus vaccine could prevent significant morbidity.

Indigenous children living in arid Central Australia experience frequent outbreaks of rotavirus gastroenteritis. A widespread outbreak of G9 rotavirus infection occurred several months after introduction of the RIX4414 rotavirus vaccine. We performed a retrospective case-control study to determine vaccine efficacy during the outbreak. Two doses provided an estimated vaccine efficacy of 77.7% (95% confidence interval, 40.2%-91.7%) against hospitalization for gastroenteritis. Vaccine efficacy was 84.5% (95% confidence interval, 23.4%-96.9%) against confirmed cases of rotavirus infection. Vaccination was effective in this high-burden setting.

<p class="AbstracttextAJIE"><span lang="EN-GB">In late 2013, under the leadership of Prime Minister Abbott, the Australian Government announced a new policy designed to increase attendance rates in remote community schools—the Remote School Attendance Strategy (RSAS). The model assumed that employing local people in the program, which was designed to support parents get their children to school, would yield significant improvements and consequently improve educational outcomes. After a slight initial increase in school attendance rates, RSAS schools have seen average attendance rates decline since 2016, which now stand more than eight percentage points lower than at commencement. This article analyses My School data for Very Remote Aboriginal schools, showing how the RSAS school attendance results compare with similar non-RSAS schools. We question why the Australian Government continues to invest in a program that is not meeting its objectives, asking, what went wrong?. We do this by critically analysing 36 policy-related documents, looking for ideological clues that show why the government continues to invest in the program and how it sees it as “successful”. We conclude by raising ethical and accountability concerns about the RSAS, which lacks evidence of attendance improvement, and which potentially causes harm to its objects: First Nations students. </span></p>

Cape York’s Indigenous communities, small (<1000 people), very remote and socially complex experience significant excess health burden due to substance misuse, in particular alcohol, tobacco and cannabis. Cannabis is the main psychoactive substance available where alcohol is controlled. Data from the Cape York Cannabis Project (CYCP) exemplified a lack of convincing effect of substance misuse programs in these contexts with controlled and quasi‐experimental study designs. This thesis considered theory‐driven evaluation for substance misuse harm and demand reduction programs in the context of Indigenous Australian communities.

Clinical relevance Understanding the prevalence of vision conditions in a population is critical for determining the most appropriate strategies for detecting and correcting eye conditions in a community. This is particularly important in very remote regions where access to vision testing services is limited. Background Although recent studies have provided detailed analyses of the prevalence of vision conditions in Aboriginal and/or Torres Strait Islander children in urban and regional areas of Australia, there is a paucity of research examining vision conditions in children in remote regions. Importantly, a significant proportion of the population in remote and very remote regions identify as Aboriginal and/or Torres Strait Islander people. Methods Comprehensive eye examinations were provided to 193 primary school children in a very remote Australian region. Ninety eight percent of children identified as Aboriginal and/or Torres Strait Islander. The eye examination included measures of visual acuity, cycloplegic autorefraction, binocular vision and accommodative function, ocular health and colour vision. Previous history of eye examinations and refractive correction were assessed through parental questionnaire. Results Although the average unaided vision in the population was good (mean: 0.02?±?0.13 logMAR) and the prevalence of reduced unaided visual acuity (>0.3 logMAR in either eye) was low (4%), vision conditions were detected in 32% of children. The most common conditions were clinically significant refractive errors (18% of children) and binocular vision or accommodative disorders (16%). Of the total population of children tested, 10% had previously had an eye examination, and 2% were reported to have previously been prescribed spectacles. Conclusions In this population of children in a very remote Australian region, up to 1 in 3 children had a vision condition, with many of these conditions being uncorrected and undetected. These findings highlight the important need for additional resources to be made available to very remote communities for the detection and correction of vision conditions in childhood.

The early waves of marketising reform in Australian government service delivery were relatively slow to impact on policies and programs targeting First Nations people. The portfolio of Indigenous Affairs is widely recognised as a highly complex area of policymaking, given the challenges of service delivery in remote areas, the language and cultural barriers and the long-term impacts of processes of colonisation, dispossession, exclusion and marginalisation. For many decades, the Commonwealth Government funded separate delivery of services and programs for First Nations people and supported a broad policy approach based on Indigenous self-determination. However, since the Howard era, marketisation in social services has been increasingly applied to Indigenous services and separate policy delivery has been replaced with 'mainstreaming' of services.

The push to improve Indigenous student retention and completion rates in higher education programs is a strategic goal across Australian universities. Similarly, the notion of decolonizing education to allow for a more culturally relevant educational experience is being discussed in university curricula development. In this article, we highlight challenges within the current neoliberal political context influencing a decolonized approached to higher education. We will draw on experiences from a case study of a creative therapy course situated within a Social Work program at a regional university. A team of Indigenous and non-Indigenous researchers will propose a framework for navigating pedagogical and administrative challenges to design a course that serves as a powerful tool to advocate for changes in higher education and social work systems. We suggest that this framework can be used to build valuable connections across Indigenous and Western knowledge systems and promote truth-telling in the social work context. Finally, we argue that our framework for decolonising education is inter-disciplinary and a useful tool in helping staff and students take back their knowledge from colonial power structures.

Background: Aboriginal and Torres Strait Islander people avidly use technology for a variety of purposes. Digital health technologies offer a new way to build on Aboriginal and Torres Strait Islander peoples propensity for early adoption and innovation with technology. Only limited research has focused on mature aged adults in non-urban locations as partners in digital health research and there is no research related to wearables for health tracking for this cohort.Objective: This paper provides insights into mature aged Aboriginal and Torres Strait Islander adults interest, use and trust of social media, apps and wearables to gain health information and manage health.Methods: This cross-sectional survey study was co-designed and co-implemented with Aboriginal Community Controlled Health Services (ACCHS) in three locations in New South Wales, Australia. The 13-item survey was administered via a semi-structured interview.Results: Aboriginal and Torres Strait Islander adults (n = 78), in regional, rural and remote locations indicated their interest in and use of apps and wearables for health purposes. Mature aged participants, particularly women, used Facebook, ACCHS websites and YouTube for acquiring health-related information which they then shared online and in real life with a diversity of family, friends and colleagues. Conclusions: Aboriginal and Torres Strait Islander people are using digital health technologies to acquire and share health information and want to use apps and wearables for health management. Co-designed research enables a greater understanding of the diverse needs for different cohorts and informs culturally responsible design. Broader use of co-design will foster effective user-focused digital health communication and health-management.

Yuelamu community is a small community located in the Central Desert region of the Northern Territory (NT), about 43km west of the major community of Yuendumu, and 300km north-west of the regional centre of Alice Springs. The traditional owners of Yuelamu are the Anmatyerr (Anmatjere) people. The first research visit to Yuelamu was undertaken from 5th to 7th May 2022, with stakeholder interviews conducted in Yuendumu and Alice Springs on the 9th and 10th May. Based on 37 surveys and 12 stakeholder interviews, this report outlines the initial findings from the 2022 visit, and highlights the current access and use of media, telecommunications and online services, as well as the digital inclusion and service delivery challenges in Yuelamu and across the Central Desert region. This report is intended to assist local and regional agencies, including PAW Media, Central Land Council Central Desert Regional Council, as well as Northern Territory Government, to better understand the key barriers to digital inclusion in Yuelamu and the region and community aspirations for the future. It is designed to provide a basis for a local digital inclusion plan. This report will assist in identifying infrastructure and program needs to enable a targeted approach for advocacy with government and industry stakeholders. The report will be updated following research visits in 2023 and 2024.

Australian higher education participation continues to expand, yet in unequal ways. Regional, rural, and remote (RRR) student participation is stubbornly stalled, despite sustained research and policy initiatives to support these cohorts. To address this complex issue, we interviewed 10 RRR principals in Queensland and Victoria to explore specific challenges that face RRR communities, as well as collate strategies and solutions. Our findings highlighted the importance of leveraging and developing local knowledge and expertise to equip students with careers education, as well as the need to promote a positive narrative about RRR community life. A key theme that emerged from participants was the need to dispel the myth that students needed to leave their communities to achieve their goals or find career success. The findings from this paper point to a need for educational outreach programs to continue to develop context-specific, locally informed programs and support that align with RRR communities' values and ways of life.

This report presents the results of a study that forms one component of a major National Survey of Remote Aboriginal and Torres Strait Islander Artists. The Survey was undertaken in the Department of Economics at Macquarie University progressively across six regions in remote Australia. This Report relates the Survey in Region 4: Central Desert NT and APY Lands SA.

This Report presents the results of a study that forms one component of a major National Survey of Remote Aboriginal and Torres Strait Islander Artists. This Report relates to the implementation of the National Survey in Region 3: The North-West region of the Northern Territory, a region that includes the Tiwi Islands.

This report presents the results of a study that forms one component of a major National Survey of Remote Aboriginal and Torres Strait Islander Artists. The report relates to the implementation of the National Survey in Region 2 (Arnhem Land).

Over the years in the Northern Territory, there has been a growing interest among educators and Indigenous people in remote communities to improve community school leadership and school community partnerships as a means of improving Indigenous school outcomes. This study has investigated and recorded the stories of five Indigenous female school principals in the Top End of the Northern Territory on their leadership approaches in negotiating school community partnerships in their respective communities. The female principals are in many ways regarded as pioneering leaders of their remote community schools in their own right, and are held in high esteem in their communities - qualities which made them ideal participants for this study. The study utilised a Biographic Narrative Interpretive Methodology (BNIM) to record, interpret and analyse the data for the study. Three interviews were conducted with each participant over a period of time. While the study revealed that Indigenous female principals have achieved major advancements in their individual and collective ways in working collaboratively with school communities, they also experienced enormous challenges and constraints in their efforts to demonstrate good educational leadership and work in partnership with their communities. Some of the challenges included their roles as women in an Aboriginal community; balancing school leadership, family and community commitments; and, complexities of working with the mainstream. In narrating their stories, the female principals maintained that cultural values play a significant role in building such relationships and advocated for language and culture to be supported through commitment at the system level. Additionally, they revealed that community school leadership should be flexible and context bound as rigid bureaucratic structures are inappropriate for Indigenous community setting.;As such they advocated for culturally appropriate relationships between systems and local communities. Notably, among many other issues, they maintained that all appointments of principals in remote community schools must, at all times, be accompanied by adequate consultation and effective participation of community leaders and/or their relatives and community representatives. Such collaboration and cooperation between communities, schools, and the system is likely to improve relationships between schools and communities. Additionally, the Indigenous female principals in this study emphasised the importance of supporting dimensions of leadership, for example, shared leadership as a reflection and relatedness of their culture. Such dimensions they believe are required for developing and sustaining school community partnerships.

This chapter explores the assessment experiences of mature-aged undergraduate university students in regional and remote Australia by analysing 51 student interviews and open-ended survey questions from a national mixed-methods study. The qualitative data analysis found that students did not always understand what was required in assessment tasks; experienced difficulties in receiving timely clarification of such tasks; and had practical concerns around deadlines and challenges with receiving extensions. These experiences exacerbated the stress experienced in undertaking assessment tasks. Positive experiences were also reported – particularly, receiving support from academic staff, as well as assessment tasks being contextualised for a student's regional/remote location. The themes are interpreted from the perspective of Bronfenbrenner's ecological systems theory to identify the layers of the ecological system and the array of influences that impact on the students’ experiences of assessment. These include the neoliberalisation of higher education, the strain on higher education budgets, and the resultant casualisation of the university teaching workforce, as well as university rules and regulations that are at odds with students’ needs and experiences. The chapter concludes by proposing some approaches to moving towards more inclusive assessment.

INTRODUCTION: Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2 across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems level analysis of the issues influencing the coverage, quality and responsiveness of health services across this region by examining the available published literature and identifying key policy-relevant gaps. METHODS: A scoping review design was adopted with searches incorporating both peer-reviewed and grey literature (eg strategy documents, annual reports and budgets). Grey literature was predominantly sourced from websites of key organisations in the three northern jurisdictions, with peer-reviewed literature sourced from electronic database searches and reference lists. Key articles and documents were also contributed by health sector experts. Findings were synthesised and reported narratively using the WHO health system 'building blocks' to categorise the data. RESULTS: From the total of 324 documents and data sources included in the review following screening and eligibility assessment, 197 were peer-reviewed journal articles and 127 were grey literature. Numerous health sector actors across the north - comprising planning bodies, universities and training organisations, peak bodies and providers - deliver primary, secondary and tertiary healthcare and workforce education and training in highly diverse contexts of care. Despite many exemplar health service and workforce models in the north, this synthesis describes a highly fragmented sector with many and disjointed stakeholders and funding sources. While the many strengths of the northern health system include expertise in training and supporting a fit-for-purpose health workforce, health systems in the north are struggling to meet the health needs of highly distributed populations with poorly targeted resources and ill-suited funding models. Ageing of the population and rising rates of chronic disease and mental health issues, underpinned by complex social, cultural and environmental determinants of health, continue to compound these challenges. CONCLUSION: Policy goals about developing northern Australia economically need to build from a foundation of a healthy and productive population. Improving health outcomes in the north requires political commitment, local leadership and targeted investment to improve health service delivery, workforce stability and evidence-based strengthening of community-led comprehensive primary health care. This requires intersectoral collaboration across many organisations and the three jurisdictions, drawing from previous collaborative experiences. Further evaluative research, linking structure to process and outcomes, and responding to changes in the healthcare landscape such as the rapid emergence of digital technologies, is needed across a range of policy areas to support these efforts.