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The 'invisible homeless' - challenges faced by families bringing up their children in a remote Australian Aboriginal community.

ABSTRACT: BACKGROUND:Insufficient and inadequate housing remain serious and enduring problems in remote Aboriginal communities in the Northern Territory (NT) of Australia. Housing is recognised as a key determinant of persisting inequities between Aboriginal and other Australians in health, as well as education and employment outcomes which in turn impact on health. In our qualitative study exploring strengths and challenges related to early childhood in a remote NT community, insufficient housing emerged as the greatest challenge families experience in 'growing up' their children. METHODS:The "Growing up children in two worlds" study engaged Yol?u (Aboriginal) and other researchers in a culturally responsive qualitative research process. Methods included video ethnography and in-depth interviews with six case study families as well as participant observation and interviews with a wide range of other community members. Data collection and analysis occurred through an iterative and collaborative process and the findings related to housing are the focus of this article. RESULTS:Concerns about crowded and insecure housing were pervasive in the study community where many families are, in effect, homeless. Most rely on extended family to provide accommodation and some never find a secure and stable space in which to bring up their children. Absence of control over their living conditions is a key element underlying many of the sources of distress associated with crowded housing. The lack of food security, sharing sickness and disturbances in the night affecting sleep are just some of the challenges that generate conflict between family members and impact on health, wellbeing, work and school attendance. Although interaction with other family members is highly valued, the ambition of most participants is for independent and secure accommodation in which they can safely 'grow up' their children. CONCLUSIONS:Yol?u who live with the consequences of crowded and insecure housing want their voices to be heard. They best understand the challenges they face and their perspectives must inform the solutions. Equitable access to housing through sufficient and sustained investment in an integrated approach, engaging all stakeholders, is needed. This is essential to address persisting inequities between Aboriginal and non-Aboriginal Australians in health and other outcomes.

SUBMITTER: Lowell A

PROVIDER: S-EPMC6299657 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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The 'invisible homeless' - challenges faced by families bringing up their children in a remote Australian Aboriginal community.

Lowell Anne A Maypilama Ḻäwurrpa Ḻ Fasoli Lyn L Guyula Yalŋarra Y Guyula Abbey A Yunupiŋu Megan M Godwin-Thompson Jenine J Gundjarranbuy Rosemary R Armstrong Emily E Garrutju Jane J McEldowney Rose R

BMC public health 20181218 1

<h4>Background</h4>Insufficient and inadequate housing remain serious and enduring problems in remote Aboriginal communities in the Northern Territory (NT) of Australia. Housing is recognised as a key determinant of persisting inequities between Aboriginal and other Australians in health, as well as education and employment outcomes which in turn impact on health. In our qualitative study exploring strengths and challenges related to early childhood in a remote NT community, insufficient housing ...[more]

PMID: 30563487

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Project description:IntroductionThe population-based (Lililwan) study of fetal alcohol spectrum disorder (FASD) revealed a high prevalence of FASD in the remote communities of the Fitzroy Valley, Western Australia (WA) and confirmed anecdotal reports from families and teachers that challenging child behaviours were a significant concern. In response, Marninwarntikura Women's Resource Centre initiated a partnership with researchers from The University of Sydney to bring the positive parenting program (Triple P) to the Valley. Triple P has been effective in increasing parenting skills and confidence, and improving child behaviour in various Indigenous communities.Methods and analysisExtensive consultation with community leaders, service providers, Aboriginal health networks and academic institutions was undertaken and is ongoing. Based on community consultations, the intervention was adapted to acknowledge local cultural, social and language complexities. Carers of children born after 1 January 2002 and living in the Fitzroy Valley are invited to participate in Group Triple P, including additional Stepping Stones strategies for children with complex needs. Programme are delivered by local community service workers, trained and accredited as Triple P providers or 'parent coaches'. Assessments for parent coach pretraining and post-training includes their perceived ability to deliver the intervention and the cultural appropriateness of the programme. Carers complete preintervention and postintervention and 6-month follow-up assessments of parenting practices, self-efficacy and child behaviour.Ethics and disseminationApproval was granted by the University of Sydney Human Ethics Committee, WA Aboriginal Health Ethics Committee, WA Country Health Services Ethics Committee and Kimberley Aboriginal Health Planning Forum. Consultation with community is imperative for efficacy, engagement, community ownership and sustainability of the programme, and will be ongoing until findings are disseminated. Anonymous findings will be disseminated through peer-reviewed journals, community feedback sessions and scientific forums.

Project description:BackgroundStrongyloides seroprevalence is hyper-endemic in many Australian Aboriginal and Torres Strait Islander communities, ranging from 35-60%. We report the impact on Strongyloides seroprevalence after two oral ivermectin mass drug administrations (MDAs) delivered 12 months apart in a remote Australian Aboriginal community.MethodsUtilizing a before and after study design, we measured Strongyloides seroprevalence through population census with sequential MDAs at baseline and month 12. Surveys at months 6 and 18 determined changes in serostatus. Serodiagnosis was undertaken by ELISA that used sonicated Strongyloides ratti antigen to detect anti-Strongyloides IgG. Non-pregnant participants weighing ?15 kg were administered a single 200 ?g/kg ivermectin dose, repeated after 10-42 days if Strongyloides and/or scabies was diagnosed; others followed a standard alternative algorithm. A questionnaire on clinical symptoms was administered to identify adverse events from treatment and self-reported symptoms associated with serostatus.FindingsWe surveyed 1013 participants at the baseline population census and 1060 (n = 700 from baseline cohort and 360 new entrants) at month 12. Strongyloides seroprevalence fell from 21% (175/818) at baseline to 5% at month 6. For participants from the baseline cohort this reduction was sustained at month 12 (34/618, 6%), falling to 2% at month 18 after the second MDA. For new entrants to the cohort at month 12, seroprevalence reduced from 25% (75/297) to 7% at month 18. Strongyloides positive seroconversions for the baseline cohort six months after each MDA were 2.5% (4/157) at month 6 and 1% at month 18, whilst failure to serorevert remained unchanged at 18%. At 12 months, eosinophilia was identified in 59% of baseline seropositive participants and 89% of seropositive new entrants, compared with 47%baseline seronegative participants and 51% seronegative new entrants. Seropositivity was not correlated with haemoglobin or any self-reported clinical symptoms. Clinical symptoms ascertained on the day of treatment and 24-72 hrs after, did not identify any adverse events.SignificanceTwo community ivermectin MDAs delivered 12 months apart by trained Aboriginal researchers in collaboration with non-Indigenous researchers resulted in a sustained and significant reduction in Strongyloides seroprevalence over 18 months. Similar reductions were seen in the baseline cohort and new entrants.

Dataset Information

The 'invisible homeless' - challenges faced by families bringing up their children in a remote Australian Aboriginal community.

Publications

The 'invisible homeless' - challenges faced by families bringing up their children in a remote Australian Aboriginal community.

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