Is this the answer to a better start for remote Indigenous kids?
Early childhood is a crucial stage of a human being’s development. It impacts the rest of their life and, by extension, society. But sadly, this can be a very difficult stage for many Indigenous children in remote Australia. Dr Gary Robinson is working with agencies who are trying to change that.
Dr Robinson's doing that by evaluating a multi-million dollar early childhood program. His team is exploring how the program is working, and whether it can be improved.
“Around half of the Aboriginal children in the Northern Territory have had at least one child protection notification by the age of five."
"This is way above the rates we see in the general population level,” explains Dr Robinson, who heads up the Centre of Child Development and Education at Menzies School of Health Research. Hopefully, this can be reduced by better early support for parents.
To provide remote Indigenous families with more support in children’s early years, the Northern Territory government has committed funding over five years to evaluate the outcomes of its new Maternal Early Childhood Sustained Home-visiting (MECSH) program.
The program is a nurse home visiting program with a difference.
It goes beyond just one or two home visits from a nurse; it gives remote Indigenous families in the NT access to visiting nurses in their communities several times from pregnancy through a child’s early years.
In the first year, mothers and their babies are visited at least 19 times at home or as agreed by the mother.
This is a big increase on the usual health care received by new mothers. The aim of the program is to improve access and build the capacity of Indigenous parents in remote NT to provide safe and responsive care for their newborns at home.
And in turn, a better early start for Indigenous children in remote communities.
Big cities to remote communities
“These types of nursing programs have been around for a while,” says Dr Robinson. “The NT Government’s MESCH program is a variant on nurse home visiting that’s been trialed in Western Sydney, Tasmania, Victoria and also internationally.
“But, this program – one that’s been developed in cities – has never been implemented in remote Aboriginal communities before.”
So, how do we know it will work?
“There will need to be some changes to the program, and there’ll be some challenges,” says Dr Robison.
“How do we make sure Indigenous mothers and children are getting value out of it? Who does the program work best for?
“This is why it’s crucial that we evaluate the program as it’s rolled out and understand the adaptations that are made. It’s not a one-size-fits-all model."
“And we are seeking research students to work on this exciting, challenging research. Projects like this are a once-in-a-career opportunity to work with Aboriginal medical services in the Northern Territory to make a measurable impact,” he says.
This evaluation research is well worth doing. If the MESCH program works as it’s been intended, it’ll provide invaluable intervention for vulnerable and at-risk mothers in situations of socio-economic disadvantage. Which will, in turn, improve maternal and child health and development – to the benefit of individuals and broader society.
Unpacking community perceptions
The secret to success is understanding how Indigenous communities perceive the program. That will help to understand the obstacles it faces and to make a plan to overcome these.
“Our research wants to understand the context of remote parenting; the different family structures and cultural systems. How does the MESCH program work in this particular cultural context?” explains Dr Robinson.
“What do parents like about it? Do they have any concerns? Our research is qualitative – we want to know where parents are coming from, what they're grappling with, their perspectives on the health services they're receiving.”
The team’s research is a two-way street. As well as looking at the impact on families, he’s evaluating the experience and observations of the visiting nurses and local health practitioners.
For the remote Aboriginal Community Controlled Health Services implementing MECSH, involvement of local Aboriginal health practitioners is a priority.
“The goal is to come up with a model that works best in the cultural contest of remote communities; so that the nurses have support from Aboriginal health practitioners, and so that the mother feels understood,” he explains.
Overlaying their qualitative research, Dr Robinson’s team is also looking at health services data on mothers’ and children’s development. This includes services they accessed, milestones, risks factors and unpacking what that data says about the program.
Ultimately, this data will form the basis of recommendations to government on whether the program is working - and how to make it work better - to the benefit of patients, Aboriginal Health Services and society as a whole.