ABORIGINAL FAMILY HEALTH STRATEGY 2011 2016 Respodig to Family Violece i Aborigial Commuities
Artwork NSW Departmet of Health would like to ackowledge Adam Igram of the Wiradjuri atio, whose artwork appears i this documet. The paitig reflects the artist s cocept of strog families ad commuities; the hads borderig the paitig represet the commuity ecirclig the family. The large hads at the cetre of the paitig holdig a sphere represet mother earth holdig the su. The figures which appear above the su represet the family, ad the gree leaves ad yellow fruits which appear below the su represet the traditioal fruits eate by Aborigial people. This artwork has bee edited for the purpose of better represetig the cocept of the Aborigial Family Health Strategy. New South Wales Health Departmet for ad o behalf of the Crow i right of the State of New South Wales. Ackowledgemets The NSW Health Aborigial Family Health Strategy 2011 reflects the iput of may idividuals who have cotributed to its developmet by participatig i cosultatios ad providig expert advice ad ogoig feedback. NSW Health would like to thak members of the followig orgaisatios for their cotributio: Aborigial Family Health Worker s Network Aborigial Affairs NSW Australia Family & Domestic Violece Clearighouse Aborigial Health & Medical Research Coucil Commuity Services Educatio Cetre Agaist Violece Natioal Child Protectio Clearig House New South Wales Police Office for Wome s Policy, Departmet of Premier ad Cabiet Primary Health ad Commuity Parterships Brach, NSW Departmet of Health NSW DEPARTMENT OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900 www.health.sw.gov.au This work is copyright. It may be reproduced i whole or i part for study traiig purposes subject to the iclusio of a ackowledgemet of the source. It may ot be reproduced for commercial usage or sale. Reproductio for purposes other tha those idicated above requires writte permissio from the NSW Departmet of Health. Suggested citatio: NSW Departmet of Health (2011) NSW Health Aborigial Family Health Strategy, Cetre for Aborigial Health. Sydey. NSW Departmet of Health 2011 SHPN (CAH) 070177 ISBN 978 1 74187 194 4 For further copies of this documet please cotact: Better Health Cetre Publicatios Warehouse PO Box 672 North Ryde BC, NSW 2113 Tel. (02) 9887 5450 Fax. (02) 9887 5452 Further copies of this documet ca be dowloaded from the NSW Health website www.health.sw.gov.au Note: For the purposes of this paper Aborigial refers to both Aborigial ad Torres Strait Islader people. The term ackowledges that Torres Strait Isladers are a separate people, ad Aborigial people are the origial ihabitats of New South Wales. April 2011
Statemet of Commitmet We ackowledge that we are located o the lads of the Cammeraygul people. The Cammeraygul are the traditioal custodias of this lad ad are part of the greater Eora Natio. We pay our respects to past, preset ad future acestors of the Aborigial atios. The NSW Departmet of Health ackowledges that we are located o the lads of the Cammeraygal people. The Cammeraygal are the traditioal custodias of this lad ad are part of the greater Eora Natio. We pay our respects to past, preset ad future acestors of the Aborigial atios. This Statemet of Commitmet, origially siged o Sorry Day, 26 May 2010, is a ackowledgmet of regret over past practices ad policies which have impacted o the social ad emotioal wellbeig of Aborigial people ad their health. We recogise Aborigial people as the First Natios People of Australia ad the traditioal owers ad custodias of lad. Aborigial people have lived here for over 60,000 years ad are recogised as beig the oldest livig, cotiuous culture of the world, with uique laguages ad spiritual relatioships to the lad ad seas. We are strogly committed to improvig the physical, cultural, spiritual ad family wellbeig of Aborigial people i this State. The NSW Departmet of Health, are Sorry for the pai ad loss placed o the lives of Aborigial people who have bee dislocated from their culture, displaced from their homelads ad watched their childre beig take away. We have made this Statemet of Commitmet to cotiue to: Uphold ad apply cultural protocols such as `Welcome to Coutry or Ackowledgmet of Coutry ; Ackowledge ad respect Aborigial cultural idetity, practices ad beliefs by workig i partership with Aborigial peoples through the use of the NSW Aborigial Health Partership Agreemet; Use the Aborigial Health Impact Statemet whe developig or reviewig sigificat policies ad programs; ad Implemet agreed actios that support delivery of services ad programs to Aborigial people i NSW. For the NSW Departmet of Health, this Statemet of Commitmet meas buildig our cultural competece ad workig to deliver sustaiable health outcomes ad cotribute to closig the health gap betwee Aborigial ad o-aborigial people. NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 1
PAGE 2 NSW Health NSW Aborigial Family Health Strategy 2011 2016
Cotet Foreword...4 The Strategy at a glace...5 Itroductio...6 The burde of family violece...7 Defiig family violece...7 The evidece...7 Cotributig factors for Aborigial people...8 Earlier approaches...9 Aborigial Family Health Strategy...9 Broader NSW Health system approach...9 Review ad the eed for chage...10 Review of Aborigial Family Health Strategy...10 Chagig policy cotext...11 Goal of the NSW Aborigial. Family Health Strategy...15 Aims of the Strategy...15 Priciples...16 The Way Forward...17 A itegrated approach...17 Buildig workforce capacity...18 The Model Upacked...19 Elemet 1 Strategic Leadership...19 Elemet 2 Effective Service Delivery...19 Elemet 3 Culturally Competet Workforce...19 Elemet 4 Strog Commuity Capacity...20 Healig ad the Aborigial Family Health Strategy...20 Me ad the Aborigial Family Health Strategy...21 Research ad evaluatio...21 Evidece based good practice...21 Program logic...22 A family based approach...26 Sheree s Story...26 Diagram of service liks...29 Implemetatio...30 Aborigial Family Health Service Guidelies...30 Implemetatio Committee...30 Implemetatio Actios...30 Aborigial Family Health Actio Plas...30 Aborigial Family Health Actio Groups...31 Implemetatio Actios...32 Elemet 1 Strategic Leadership...32 Elemet 2 Effective Service Delivery...33 Elemet 3 Culturally Competet Workforce...35 Elemet 4 Strog Commuity Capacity...36 Measurig Progress...37 Measures of success...37 Log term success...37 Moitorig ad Evaluatio...39 Refereces...40 Appedix...44 Acroyms... 44. NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 3
Foreword NSW Health is committed to reducig the icidece ad impact of family violece by workig i partership with Aborigial people ad their commuities. This revised editio of the NSW Health Aborigial Family Health Strategy (2011-2016) will guide activity that respods to family violece i Aborigial commuities over the ext five years by supportig work curretly uderway ad idetifyig ew opportuities to achieve safer ad stroger Aborigial families ad commuities. programs to esure appropriate itervetio optios for all families experiecig family violece. This Strategy will promote a coordiated respose across the service etwork so that Aborigial families beefit from all services. The revisio of the Strategy has ivolved a extesive cosultatio process to esure it is a comprehesive ad relevat strategy which guides activity i respose to family violece across the health system, icludig the commuity cotrolled sector. The Aborigial Family Health Strategy was first released i 1998 ad preseted a iovative approach for workig with family violece withi a cultural cotext. The Strategy has bee revised with the aim of egagig maistream services ad facilitatig the NSW Health respose to whole of govermet iitiatives addressig family violece. I take this opportuity to ackowledge the sustaied effort of all those ivolved i this complex ad challegig field ad offer my support ad ecouragemet. Thak you for your cotributio ito the future. I wish you success i your edeavours. The Aborigial Family Health Strategy is uique amog family violece prevetio ad itervetio strategies i its focus o the Aborigial family ad culture, ad its healig approach. At the same time it is ackowledged that NSW Health is curretly implemetig a rage of policies ad Dr Mary Foley Director-Geeral The NSW Aborigial Family Health Strategy is dedicated to the Aborigial Family Health Workers who have worked tirelessly, ofte with little recogitio, to reduce the impact of family violece i Aborigial commuities. Their work has give hope for the future to the may families whose lives have bee impacted upo by family violece. I particular this Strategy is dedicated to Sera Iacu (1962-2010) of Awabakal Aborigial Medical Service ad the Educatio Cetre Agaist Violece. PAGE 4 NSW Health NSW Aborigial Family Health Strategy 2011 2016
The Strategy at a glace Target Populatio Aborigial families ad commuities i NSW. Goal Ad Aims: Aborigial Family Health Model Of Care The foudatio of this model is Aborigial culture ad family. Its core elemets are: That all Aborigial people i NSW live safe ad healthy lives free of family violece. This will happe whe we: Reduce the icidece ad impact of family violece i Aborigial commuities. Build the capacity ad stregth of idividuals ad commuities to prevet, respod to, ad recover from, family violece. Nurture the spirit, resiliece ad cultural idetity that build Aborigial families. Burde Of Family Violece: I 2008 the rates of reported victims of domestic violece were 6 times higher for Aborigial females tha o-aborigial females (3,148 per 100,000 ad 511 per 100,000, respectively), ad 4 times higher i Aborigial males tha o-aborigial males. (NSW Bureau of Crime Statistics ad Research, 2010). The umber of child protectio reports made to Commuity Services for Aborigial childre ad youg people has icreased by more tha 3 times i the past 8 years, from 18,348 i 2001/02 to 59,375 i 2008/09. Durig the same period the icrease for the o- Aborigial populatio was 1.7 times, from 141,295 reports made i 2001/02 to 250,301 i 2008/09. (NSW Departmet of Commuity Services, 2007a ad 2007b ad additioal data from the Cliet Iformatio System (CIS), ad the Key Iformatio ad Directory System (KIDS) Aual Statistical Extract). Strategic leadership. Effective service delivery Culturally competet workforce Strog Commuity capacity The model is built o the foudatio of a healig approach, ad research ad evaluatio will iform the implemetatio of each elemet. Healig Healig Effective service delivery Strategic leadership Evidece Family ad Culture Research Strog commuity capacity Culturally competet workforce Healig Healig NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 5
Itroductio The NSW Aborigial Family Health Strategy 2011 2016 (the Strategy) sets out NSW Health s pla to respod to family violece i Aborigial commuities over the ext five years. It is a Strategy that iforms the respose at both strategic ad operatioal levels. This Strategy builds o a rage of ew ad existig iitiatives focussed o reducig the icidece ad impact of family violece i Aborigial commuities i NSW. I particular, it builds o the successful work of Aborigial Family Health Workers (AFHWs) ad the Educatio Cetre Agaist Violece. This Strategy has bee sigificatly iflueced by Natioal ad State policy ad structural reforms that aim to improve the way that govermets ad commuities work together to prevet ad respod to family violece. I particular, the roll-out of the NSW Govermet s Keep Them Safe: A shared approach to Child Wellbeig which aims to fudametally chage the way childre ad families are supported ad protected. The goal of the Strategy is to esure that all Aborigial people i NSW live safe ad healthy lives free of family violece. To achieve this goal, the Strategy sets out a model of care that will guide the implemetatio of specific actios by Local Health Districts (LHDs), Aborigial Commuity Cotrolled Health Services (ACCHSs) ad other o-govermet Orgaisatios (NGOs) over the ext five years. This model of care is iformed by evidece based best practice, ad built o the foudatio of a healig approach. Its implemetatio will cotiue to be iformed by buildig research ad evaluatio ito program activity. This Strategy will cotribute to the provisio of a itegrated respose to family violece i Aborigial commuities based o collaboratio betwee services. The log term success of the Aborigial Family Health Strategy will be assessed from a holistic ad commuity based perspective i accordace with the priciples of Aborigial health. PAGE 6 NSW Health NSW Aborigial Family Health Strategy 2011 2016
Burde of Family Violece Defiig family violece Family violece describes all forms of violece icludig physical, emotioal, psychological, sexual, sociological, ecoomic ad spiritual i itimate, family ad other relatioships of mutual obligatio ad support (Aborigial Child Sexual Assault Taskforce 2006). The term family violece takes place withi the exteded ature of Aborigial families. Resposes eed to take accout of the diversity ad complexity of kiship ties i Aborigial commuities, ad this holistic defiitio recogise that family violece i Aborigial commuities impacts o a wide rage of ki ad commuity members. I the case of a Aborigial perso or a Torres Strait Islader, a perso has a domestic relatioship with aother perso if the perso is, or has bee part of the exteded family or ki of the other perso accordig to the Idigeous kiship system of the perso s culture. Crimes (Domestic ad Persoal Violece) Act 2007. The evidece Family violece is oe of the most serious issues affectig Aborigial commuities. It has a devastatig impact ad burde o the health ad social ad emotioal wellbeig of Aborigial commuities i NSW (NSW Departmet of Premier ad Cabiet 2009a). Domestic violece Aborigial wome cotiue to report higher levels of physical violece durig their lifetime tha do o- Aborigial wome, ad are also much more likely to experiece sexual violece ad sustai ijury. Barriers to seekig support services, ad the likelihood of receivig iadequate or iappropriate resposes, mea Aborigial wome are icreasigly vulerable to the risks ad effects of violece. I NSW Aborigial wome remai sigificatly overrepreseted amog reported victims of sexual assault ad domestic violece related assault (NSW Departmet of Premier ad Cabiet 2008b). I 2008, the rates of reported victims of domestic violece were 6 times higher for Aborigial females tha o-aborigial females (3,148 per 100,000 ad 511 per 100,000, respectively), ad 4 times higher for Aborigial males tha o-aborigial males. (NSW Bureau of Crime Statistics ad Research, 2010). The proportio of hospitalisatios due to violece was much higher amog Aborigial people (18%) compared to o-aborigial people (5%). Aborigial females are 12 times more likely to be hospitalised due to violece compared to the o-aborigial populatio (NSW Departmet of Health 2010). Child abuse Aborigial childre are sigificatly over-represeted i the child protectio system. The followig statistics provide a idicatio of the rates of child abuse i NSW: The umber of child protectio reports made to Commuity Services for Aborigial childre ad youg people has icreased by more tha 3 times i the past 8 years, from 18,348 i 2001/02 to 59,375 i 2008/09. Durig the same period, the icrease for the o- Aborigial populatio was 1.7 times, from 141,295 reports made i 2001/02 to 250,301 i 2008/09. (NSW Departmet of Commuity Services, 2007b ad additioal data from the Cliet Iformatio System (CIS), ad the Key Iformatio ad Directory System (KIDS) Aual Statistical Extract). I NSW, the rate of child sexual assault of Aborigial females uder the age of 16 years i 2004 was more tha double that of o-aborigial females. However, of all the childre who accessed services that respod to sexual assault i 2003-2004, oly 11% were Aborigial (NSW Govermet, 2007). NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 7
Ecoomic costs I 2004, Access Ecoomics reported that the cost of violece agaist wome to the ecoomy was $8.1 billio. The largest compoet of this cost was pai, sufferig ad premature mortality at $3.5 billio. If o ew actios are take to reduce the icidece ad the impact of violece agaist wome by 2021-22, the cost to the ecoomy of violece agaist wome ad their childre will have almost doubled to $15.6 billio (Access Ecoomics 2004). Log term costs Domestic violece has serious log-term effects o wome ad childre that exted well beyod the immediate experiece of family violece ad leavig a abusive relatioship. Studies highlight the log-term impact o wome ad childre i the areas of health, justice, icome security, child support, paretig ad social support services. Serious log-term impacts o wome s health may iclude a icreased risk depressio, post-traumatic stress disorder, eatig disorders, arthritis, early meopause ad cacer. (Evas 2007). The close-kit ature of the Aborigial commuity, with its kiship etworks, meas that family violece has the potetial to affect a wide circle of people. Therefore, wome who have experieced violece i Aborigial commuities may be reluctat to leave the physical ad emotioal support of families. This, combied with obligatios ad loyalties, compel wome to stay i the violet eviromet (Lumb B. ad Farrelly T. 2009) All these factors are see as cotributig to high levels of distress withi Aborigial commuities, which is ofte demostrated through destructive behaviours such as substace abuse, self-harm ad violece (Aborigial Affairs Victoria 2008). As this cotext frames a idividual s experiece of family violece it must also frame NSW Health s respose. Cotributig factors for Aborigial people The prevalece ad seriousess of family violece i Aborigial commuities must be see i the cotext of the historical, political, social ad cultural eviromets i which it occurs (Memmott, 2006). The high icidece of violet crime i some Aborigial commuities is exacerbated by factors ot preset i the broader Australia commuity. These factors that have impaired commuity fuctioig ad icreased Aborigial families vulerability to family violece iclude: dispossessio from lad ad traditioal culture breakdow of commuity kiship systems ad erosio of traditioal lores ad customs racism ad vilificatio ecoomic exclusio ad etreched poverty effects of overcrowdig ad iadequate housig the effects of istitutioalisatio ad child removal policies iherited grief ad trauma the loss of traditioal Aborigial female roles, male roles, ad status PAGE 8 NSW Health NSW Aborigial Family Health Strategy 2011 2016
Earlier Approaches Aborigial Family Health Strategy I 1998, the NSW Departmet of Health released the Aborigial Family Health Strategy. The Strategy was origially developed with fuds received through the Natioal Wome s Health Program. It became the Departmet s first step towards workig i partership with Aborigial commuities to address family violece ad sexual assault i Aborigial commuities. The Strategy provided a framework for workig with cocers about family violece i a culturally appropriate maer ad i partership with commuities. A major focus of the origial Strategy was the fudig of AFHWs to work o locally based projects. Drawig o holistic approaches, AFHWs have provided critical support to families dealig with family violece. Projects were established i a umber of regioal locatios ad maily withi Aborigial Commuity Cotrolled Health Services (ACCHSs). The core role of AFHWs icludes a mix of idividual ad family support activities, icludig iitial crisis support advocacy ad referral to other services. Their work also comprises broader commuity developmet ad educatio strategies, with a focus o prevetio ad early itervetio. AFHWs have a importat role i supportig families experiecig family violece. This role icludes short periods of itesive support i crisis situatios to protect the safety of family members experiecig family violece ad less itesive support as cliets gai kowledge ad awareess of their optios ad rights ad other support mechaisms are established. Broader NSW Health system approach The eeds of Aborigial people affected by family violece may be met by a wide rage of workers employed withi NSW Health ad other govermet agecies, the ACCHSs sector ad other NGOs. These workers may be i positios specifically established to respod to family violece ad are appropriately traied such as Domestic ad Family Violece Workers, Sexual Assault ad Child Sexual Assault Workers ad Cousellors. However, may other workers address these issues while workig i Drug ad Alcohol, Metal Health, Wome s Health ad Materal Health. Some of these positios are filled by Aborigial staff but the majority are ot. Commoly, services are delivered separately to victims of domestic ad family violece, sexual assault ad child abuse ad eglect. This fractured respose, withi idividual service streams, does ot always recogise that the forms family violece occurs simultaeously are ot distict from each other i the lives of adults ad childre ad ca occur over a lifetime (NSW Departmet of Health 2011). Recogitio of the eed for a more family cetred care is icreasigly reflected i the developmet of NSW Health policy which impacts o the idetificatio of families experiecig a rage of vulerabilities which may iclude family violece. The related care plaig ad service co-ordiatio required to esure appropriate itervetios may be ehaced by more culturally competet ad holistic approaches promoted by the Aborigial Family Health Strategy. AFHWs provide a service that aims to respod to local eeds ad cotexts, actively egage local commuities, icludig Elders ad other commuity leaders, ad relevat govermet agecies ad icorporate healig while promotig Aborigial idepedece ad empowermet. Further detail o the role of the AFHWs is available i the AFHW Operatioal Guidelies at http://www.health.sw. gov.au/policies/gl/2009/gl2009_001.html (NSW Departmet of Health 2009). NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 9
Review ad the eed for chage Review of Aborigial Family Health Strategy A review of the Aborigial Family Health Strategy (McDoald, 2005) foud that it had provided a comprehesive, holistic ad family cetred approach, settig the bechmark for other approaches to family violece i Aborigial commuities. The 2005 review recommeded that the Strategy be revised to focus o its core elemets ad the developmet of supportive ifrastructure. Durig the revisio it was decided the complexity of issues ecessitated icreased cosultatio. This cosultatio commeced with a review of all services fuded uder the Strategy durig 2008. It ivolved meetigs o locatio with the AFHWs ad, i some istaces, their lie maagers ad more seior maagemet. The reviews idetified the followig service provisio outcomes, icludig: The establishmet of, ad recurret fudig for, 20 AFHW positios (curretly 25) A pool of committed ad resiliet workers Parterships established betwee NGOs fuded uder the Strategy ad LHDs Natioal accreditatio of the Certificate IV Aborigial Family (Family Violece, Sexual Assault, ad Child Protectio), evaluated i 2010 Establishmet of the AFHW Network Release of the Operatioal Guidelies for Aborigial Family Health Workers Other agecies have dedicated fudig to establish AFHW positios workig uder the Operatioal Guidelies Developmet of the AFHW Data Collectio A strog partership with the Educatio Cetre Agaist Violece (ECAV) Importatly, the 2005 ad 2008 reviews also idetified a umber of sigificat challeges that highlighted the eed for the revisio of the Aborigial Family Health Strategy, icludig: The complexity of the issues related to family violece Poorer physical health status ad high levels of chroic stress for Aborigial people Workforce shortages isufficiet umbers both of appropriately skilled ad traied Aborigial staff ad culturally competet o-aborigial workers Bur-out amog workers, due to high workload ad the stressful ature of the work Commuity expectatios about service provisio, particularly the high level of expectatios people may have of AFHWs workig i the commuities i which they live The eed to build capacity i families ad commuities prior to itervetios, which is both time-cosumig ad resource-itesive Limited fiacial resources of agecies to provide support ad ehace the services of the Aborigial Family Health Program Lack of cosistet ad coordiated service delivery due to the various targeted locatio resposes to related iteragecy ad whole of Govermet strategies The risk of duplicatio of effort arisig from differet fudig streams Barriers to collaboratio ad parterships that result whe lack of resources limit the capacity of services to egage i ecessary activities, which if stakeholders ad orgaisatios participated i them, would place strai o existig services. PAGE 10 NSW Health NSW Aborigial Family Health Strategy 2011 2016
Chagig policy cotext The revised Aborigial Family Health Strategy is uderpied by legislatio ad Natioal ad State policy frameworks prioritisig actio o the protectio of childre from abuse, icludig sexual abuse ad other forms of family violece i Aborigial commuities. NSW Policy The NSW State Pla A New Directio for NSW: State Health Pla Towards 2010. collaboratio with the o govermet sector, we will build the capacity ad resiliece of commuities ad the idepedece, safety ad wellbeig of idividuals ad families. It icludes specific targets to Icrease the proportio of childre who have a safe ad healthy start to life ad Esure childre ad youg people i NSW, alog with their families, have access to appropriate ad resposive services whe eeded Reduce the level of domestic violece for Aborigial childre ad youg people Keep Them Safe: A Shared Approach to Child Wellbeig Stop the Violece Ed the Silece - The NSW Domestic ad Family Violece Actio Pla NSW Iteragecy Pla to Tackle Child Sexual Assault i Aborigial Commuities 2006 2011 NSW Health Policy ad Procedures for Idetifyig ad Respodig to Domestic Violece Keep Them Safe: A shared approach to Child Wellbeig (NSW Departmet of Premier ad Cabiet 2009b), which aims to fudametally chage the way childre ad families are supported ad protected, is aother sigificat policy driver for the revisio of the Aborigial Family Health Strategy. Broadly, Keep Them Safe is the NSW Govermet s five-year pla to provide appropriate support to families earlier, ad prevet as may childre ad youg people as possible from requirig statutory child protectio itervetio. The Domestic Violece Iteragecy Guidelies NSW Health / Families NSW supportig families early package Two Ways Together a 10-year pla (2003 2012) to improve the lives of Aborigial people ad their commuities Workig Together: Prevetig Violece agaist Gay, Lesbia, Bisexual ad Trasgeder People (Strategic Framework 2007 2012) Better Together: A New Directio to Make NSW Govermet Services Work Better for People with a Disability ad their Families 2007 2011 The NSW Police Force Domestic ad Family Violece Policy A Way Home: Reducig Homelessess i NSW The NSW State Pla (Departmet of Premier ad Cabiet 2010), reflects the NSW Govermet s commitmet to stregthe Aborigial commuities by prevetig ad addressig family violece. This pla states that, Through the developmet of a social iclusio ageda ad Keep Them Safe was developed i respose to Commissioer Wood s (2008) Report of the Special Commissio of the Iquiry ito Child Protectio Services i NSW. This Report was haded dow i late 2008, with 111 recommedatios aimed at stregtheig govermet ad commuity resposibility for child protectio. A particularly sigificat fidig of this Iquiry was the overrepresetatio of Aborigial childre ad youg people i the child protectio ad juveile justice systems. Cosequetly, oe aim of Keep Them Safe (NSW Departmet of Premier ad Cabiet 2008a) is to reduce this over-represetatio, through a rage of iitiatives aimed at icreasig support to Aborigial childre ad their families. Keep Them Safe also provides a commitmet to assessig the impact of all actios i the pla o Aborigial childre ad families. The Aborigial Family Health Strategy will cotribute to the implemetatio of Keep Them Safe ad other whole of govermet iitiatives. Stop the Violece Ed the Silece The NSW Domestic ad Family Violece Actio Pla (NSW Departmet of Premier ad Cabiet 2010a) is uderpied by 5 strategic directios: prevetio ad early itervetio; protectio, safety ad justice; provisio of services ad support; buildig capacity, ad data collectio ad research. NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 11
It builds o iitiatives already i place that prevet violece, better assess the risk of violece i our commuities, ad respod whe violece occurs. It also helps to ed the silece, by targetig messages that violece is ot acceptable as well as supportig wome who have experieced violece as they come ito cotact with the crimial justice system, so they become cofidet about reportig. This Pla also recogises the eed for Aborigial commuities to have alterative pathways to address domestic ad family violece. Prevetio ad Early Itervetio: improve the future life chaces ad wellbeig of Aborigial childre overall, stregthe families, ad reduce the occurrece of child sexual assault by iterveig at strategic poits, to address problem behaviours ad to support people at risk Commuity leadership ad support: improve the way govermets ad Aborigial commuities work together to miimise risk factors ad raise awareess of child sexual assault, ad to empower Aborigial leaders ad commuities to respod to child sexual assault. The NSW Iteragecy Pla to Tackle Child Sexual Assault i Aborigial Commuities 2006-2011 (NSW Govermet 2007) the Iteragecy Pla is a key policy framework that iforms the Aborigial Family Health Strategy. The Iteragecy Pla was developed by the NSW Govermet i respose to the fidigs of the 2006 The Aborigial Child Sexual Assault Taskforce report Breakig the Silece: Creatig the Future (Aborigial Child Sexual Assault Taskforce 2006), which revealed the widespread ad devastatig impact that child sexual assault is havig i Aborigial commuities, ad the overwhelmig eed commuity members have for this abuse to be preveted ad stopped. The Iteragecy Pla is a whole-of-govermet five year pla to reduce the high icidece of sexual assault of Aborigial childre i NSW. The goals of this pla are to: reduce the icidece of child sexual abuse reduce disadvatage ad dysfuctio i Aborigial commuities build up Aborigial leadership ad icrease family ad commuity safety ad wellbeig The Iteragecy Pla icludes a umber of strategic directios that relate to the Aborigial Family Health Strategy icludig: Child Protectio: the provisio of appropriate, cosistet ad effective child protectio resposes, esurig that ogoig support ad treatmet are available, ad that services ear the cofidece of their Aborigial cliets The NSW Health / Families NSW Supportig Families Early package brigs together iitiatives from NSW Health's Primary Health ad Commuity Parterships Brach ad Metal Health ad Drug & Alcohol Office. It promotes a itegrated approach to the care of wome, their ifats ad families i the periatal period. Three compaio documets form the Families NSW Supportig Families Early package: Supportig families early SAFE START strategic policy Materal ad Child Health Primary Health Care Policy Improvig metal health outcomes for parets ad ifats. Natioal Policy Natioal Partership Agreemet o Closig the Gap i Idigeous Health Outcomes (Coucil of Australia Govermets COAG 2008) Time for Actio: The Natioal Coucil s Pla for Australia to Reduce Violece agaist Wome ad their Childre 2009 2021 The Natioal Pla to Reduce Violece agaist Wome Wome s Safety Ageda Coceptual Framework for Family ad Domestic Violece Australia 2009, Australia Bureau of Statistics (ABS) Natioal Child Protectio Framework, COAG The Road Home: Homelessess White Paper Australasia Policig Strategy for the Prevetio ad Reductio of Family Violece PAGE 12 NSW Health NSW Aborigial Family Health Strategy 2011 2016
The Natioal Partership Agreemet o Closig the Gap i Idigeous Health Outcomes (COAG 2008) is a key policy documet drivig the revisio of the Aborigial Family Health Strategy. This historic agreemet icludes fudig for a rage of iitiatives that aim to improve coordiatio of service delivery for Aborigial families icludig: Iteratioal Policy The Uited Natios Covetio o the Elimiatio of All Forms of Discrimiatio agaist Wome (CEDAW) The Uited Natios Declaratio o the Elimiatio of Violece agaist Wome Makig Idigeous health everyoe s busiess, through improved multi-agecy, multi-programme ad itersectoral collaboratio ad coordiatio to meet the eeds of Idigeous families ad commuities Improvig access to targeted early detectio ad itervetio programs, particularly families with high levels of cotact with services such as child protectio, juveile justice, correctios, housig ad health services Esurig a healthy trasitio to adulthood through reduced hospitalisatios for violece ad ijury The NSW Govermet has developed a Natioal Partership Implemetatio Pla (NSW Govermet 2009) that sets out how fudig will be allocated to deliver programs to achieve the objectives of the Agreemet. Specific actios beig progressed by the Cetre for Aborigial Health, NSW Health uder this pla iclude: The revisio of the Aborigial Family Health Strategy to improve coordiatio of service delivery for high eed Aborigial families. Fudig of additioal AFHW positios located i areas of umet eed A trial of Aborigial Family Health Coordiator positios i three LHDs Additioal actios to be implemeted by NSW Health to further the Aborigial Family Health Strategy focus o improvig health service resposes to child sexual assault i Aborigial commuities iclude: Establishig additioal Aborigial child sexual assault cousellig positios i priority locatios Developig ad implemetig traiig ad workforce developmet iitiatives to esure services are culturally competet Implemetig a rage of iitiatives to ehace the availability of foresic ad medical services to victims of sexual assault, focusig o rural locatios Establishig a additioal commuity based treatmet program i Huter New Eglad based o the New Street Program, a early itervetio program for youg people who have sexually abused. The Uited Natios Hadbook for Legislatio o Violece Agaist Wome The Uited Natios Declaratio of Basic Priciples of Justice for Victims of Crime ad Abuse of Power The Uited Natios Beijig Platform for Actio The Uited Natios Milleium Developmet Goals Amesty Iteratioal: Settig the Stadard: Iteratioal Good Practice to Iform a Australia Natioal Pla of Actio to Elimiate Violece agaist Wome The Uited Natios Declaratio o the Rights of Idigeous Peoples This Strategy reflects the itetios of these iteratioal charters ad the right of every huma beig to live a life of digity that is free from violece. It also recogises the historical cotext ad the cotiuig effects of grief that impact o Aborigial commuities ad the barriers these preset i achievig the basic huma right of freedom from violece ad abuse. The Uited Natios Declaratio o the Rights of Idigeous Peoples, a documet that while ot yet havig the status of a legally bidig iteratioal treaty has bee formally edorsed by the Australia Govermet, describes the huma rights framework i a Idigeous cotext, ad sets a stadard of achievemet to be pursued i a spirit of partership ad mutual respect (Uited Natios 2007). NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 13
This Declaratio reflects the priciples of the Aborigial Family Health Strategy by recogisig that: Idigeous peoples have the right to determie ad develop priorities ad strategies for exercisig their right to developmet. I particular, idigeous peoples have the right to be actively ivolved i developig ad determiig health, housig ad other ecoomic ad social programmes affectig them ad, as far as possible, to admiister such programmes through their ow istitutios (Article 23). It also ecourages:... measures, i cojuctio with idigeous peoples, to esure that idigeous wome ad childre ejoy the full protectio ad guaratees agaist all forms of violece ad discrimiatio (Article 22). Australia is also a sigatory to the Covetio o the Elimiatio of All Forms of Discrimiatio agaist Wome (CEDAW) ad the Covetio o the Rights of the Child (CRC). The NSW legislatio that addresses domestic ad family violece, the Crimes (Domestic ad Persoal) Violece Act 2007, icludes i its objects provisios that are cosistet with these policies. The Strategy also ackowledges that family violece prevetio requires a family based approach. While recogisig that wome s traditioal culture ad authority i the commuity eeds to be promoted, it also ackowledges that me eed to be part of the solutio. PAGE 14 NSW Health NSW Aborigial Family Health Strategy 2011 2016
Goal of the NSW Aborigial Family Health Strategy All Aborigial people i NSW live safe ad healthy lives, free from family violece. The aims of the Strategy that will achieve this goal are: To reduce the icidece ad impact of family violece i Aborigial commuities. To build the capacity ad stregth of idividuals ad commuities to prevet, respod to ad recover from family violece. To urture the spirit, resiliece ad cultural idetity that builds Aborigial families. NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 15
Priciples Implemetatio of the Aborigial Family Health Strategy is supported by these priciples of Aborigial Health (Departmet of Health ad Ageig 1989). These priciples are described here with referece to family violece. Whole-of-life view of health This refers ot just to the physical well beig of a idividual but the social, emotioal, ad cultural well beig of the whole commuity a commuity i which each idividual is able to achieve his or her full potetial, thereby cotributig to whole of commuity well beig. It is a whole of life view, ad icludes the cyclical cocept of life-death-life. Self-determiatio Leadership for solutios to family violece i Aborigial commuities will be foud i Aborigial commuities. Solutios eed to be commuity devised, maaged ad implemeted to esure resposes are focussed o priority eeds, which may be differet for differet Aborigial commuities. Owership of solutios by Aborigial people will esure their effectiveess. Workig i partership This Strategy will cotribute to the provisio of a cohesive ad cooperative respose to family violece i Aborigial commuities. Based o collaboratio rather tha competitio betwee services, it will work towards reducig family violece i Aborigial commuities, while buildig the capacity ad stregth of idividuals ad commuities to recover re-empower ad rebuild family relatioships ad cultural idetity. Cultural uderstadig Aborigial family is pivotal to Aborigial culture. The Aborigial family is edurig ad eablig. It provides the emotioal stregth ad spirit for people who strive to maitai strog idetity while adaptig to chagig, ofte difficult eviromets. Family ties, loyalties ad obligatios are fudametal to the lives of Aborigial people. Aborigial families ad commuities are iterliked ad oe family or child caot be treated i isolatio from the commuity eviromet. Recogitio of trauma ad loss Frotlie workers implemetig the Strategy are workig i traumatised commuities. Programs they implemet must ackowledge the historical cotext ad the cotiuig effects of grief that impact o commuities today, i order to address the egative health impacts arisig from this trauma. Healig is a vital uderpiig elemet of the Aborigial Family Health Strategy. PAGE 16 NSW Health NSW Aborigial Family Health Strategy 2011 2016
The Way Forward Implemetatio of the Aborigial Family Health Strategy will require a flexible approach to icorporatig the recommedatios of ogoig cosultatio ad review of the AFHW Program ad the Aborigial Family Health Strategy. The Strategy will cotiue to build o achievemets ad work o mitigatig challeges it will rely o a deep commitmet to the family o the part of commuity members, ad by all those workig i services that respod to family violece i Aborigial commuities. It appears both timely ad ecessary to itegrate the Aborigial Family Health approach withi maistream health service plaig ad provisio. With the implemetatio of Keep Them Safe: A shared approach to child wellbeig (NSW Departmet of Premier ad Cabiet (2009b), Stop the Violece Ed the Silece NSW Departmet of Premier ad Cabiet (2010a) ad the cotiuig work uder the Iteragecy Pla to Tackle Child Sexual Assault i Aborigial commuities (NSW Govermet 2007), it is essetial that the multitude of activity be coordiated ad itegrated as part of a overall comprehesive respose to family violece i Aborigial commuities. Give that the Aborigial Family Health Strategy already cotais may of the elemets of good practice approaches, it is iteded that this revised Strategy ow iform those resposes provided through maistream services. This will eable improved service provisio withi a Aborigial Family Health cotext that itesifies shared uderstadigs ad shared resposibility for tacklig family violece i Aborigial commuities. Reviews of the Strategy have idetified that there was o sigle best service delivery model or orgaisatioal type for addressig family violece. Rather, effective models shared commo characteristics. Recogisig that there is limited evidece to support outcome-based practice i terms of culturally appropriate family violece models, much ca be applied i terms of culturally appropriate good practice approaches. With this i mid, service ad program itegratio is a key theme uderpiig good practice approaches. Such itegratio is cetral to the way forward i realisig the ambitios of this Strategy. A itegrated approach The most compellig reaso for a itegrated approach is that we kow the uderlyig causes ad subsequet cosequeces of family violece are similar across all of the forms of family violece ad for may people, the experieces are itertwied ad occurrig across their lives (Herma 1997). The itegratio of the strategic ad operatioal aspects of this Strategy ca be achieved by buildig o existig activity ad likig processes withi a culturally appropriate framework. A itegrated approach icludes mutual uderstadigs of shared resposibility; commitmet; support; accoutability ad agreed plaig processes (Courage Parters et al, 2005). Commo elemets of good practice approaches have bee captured to develop a Aborigial Family Health Model of Care. The applicatio of this model ito maistream approaches provides practical ways to ehace existig efforts withi a culturally competet framework. A itegrated approach to addressig family violece at both the operatioal (local) level ad the higher strategic (State ad regioal) level will require strog leadership ad support for the specific actios idetified uder the key elemets of the Aborigial Family Health Model of Care, which will have at its core Aborigial family ad culture. The elemets of the Model of Care are: strategic leadership; effective service delivery; culturally competet workforce ad; strog commuity capacity. Good practice approaches at a strategic level suggest that mechaisms eed to be i place for regioal plaig, iformatio sharig, advocacy, coordiatio, ad developmet ad maiteace of parterships. It is aticipated that a more itegrated approach at a operatioal level will cut duplicatio, ad result i less wastage of resources, fewer gaps i services, ad a overall improvemet i resposes ad outcomes for Aborigial people dealig with issues of family violece. NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 17
Buildig workforce capacity I keepig with the priciples of the Aborigial Family Health Strategy ad the evidece demostratig the importace of commuity owership ad cotrol to successful programs, the existig operatioal compoet of this Strategy the Aborigial Family Health Program will be maitaied predomiatly withi the ACCHSs ad NGO sector. This will esure that solutios to family violece are locally developed ad owed. It is evisaged that the Coordiator will provide likages betwee the NSW Health system, both uiversal ad Aborigial specific programs, NGOs, ad whole of Govermet, icludig Commowealth Govermet, iitiatives to reduce ad prevet family violece i Aborigial commuities. The role is iteded to be strategic, with a emphasis o buildig formally recogised ad active parterships withi a LHD ad regioal cotext, ad to thereby facilitate better access for Aborigial people to a rage of services supportig a holistic respose. Fudig made available uder the Natioal Partership Agreemet o Closig the Gap i Idigeous Health Outcomes has provided the opportuity to icrease workforce capacity to implemet the Strategy. Additioal AFHWs will be fuded i prioritised areas of eed, ad a trial of a ew Aborigial Family Health Coordiator positio will take place i three LHDs. The aim is to establish this Co-ordiator positio i each LHD. Aborigial Family Health Model Of Care Healig Effective service delivery Evidece Strog commuity capacity Healig Family ad Culture Healig Strategic leadership Research Culturally competet workforce Healig PAGE 18 NSW Health NSW Aborigial Family Health Strategy 2011 2016
The Model Upacked This sectio describes each elemet of the Aborigial Family Health Model of Care, ad idetifies areas of activity that will cotribute to achievig the overall goal ad aims of the Strategy. These areas of focus have iformed the Implemetatio Actios ad the framework for moitorig ad evaluatio of the Strategy. This evaluatio, combied with ogoig research, will iform the further developmet ad implemetatio of actios uder each elemet. The Model is built o the foudatio of a healig approach, which should be cosidered i the implemetatio of the actios uder each elemet. The actios will cotiue to be iformed ad ehaced by a approach which prioritises evidece-based good practice. Elemet 1: Strategic Leadership Family violece is a multifaceted ad multilayered issue that requires a equivalet respose itegrated ito policy, program developmet, maagemet ad service delivery to improve outcomes for Aborigial commuities. A coordiated ad itegrated respose as madated by the Strategy requires leadership, collaboratio ad parterships at State ad Health Service level. Strategic Leadership will ivolve: NSW Health Aborigial Health Impact Statemet (NSW Departmet of Health 2007b) Formalised parterships Aborigial Family Health Actio Plas Regioal Aborigial Family Health Actio Groups Desigated resposibility for implemetatio ad coordiatio Workforce developmet Mechaisms to showcase successful projects Advocacy for the pursuit of shared resposibility for outcomes Developmet of Aborigial Family Health Service Guidelies Elemet 2: Effective Service Delivery The Strategy ackowledges the rights ad diverse experieces of idividuals, their families ad commuities, ad the eed for flexible ad tailored resposes. Prevetio ad early itervetio are key approaches used i developig iitiatives uder the Strategy, particularly i relatio to the role of the AFHWs. Itegrated ad coordiated resposes to family violece must draw o a rage of specialist ad maistream services that support the AFHWs i their work. Effective service delivery depeds o the level of co-ordiatio ad geuie collaboratio betwee the ACCHSs Sector ad govermet agecies ad ivolves: Focus o prevetio ad early itervetio Egagemet of Aborigial people Resposes tailored to cliet eeds Accessibility of services Establishig AFHW positios i prioritised areas of eed Formal ad active liks ad pathways betwee services Educatio ad awareess raisig activities Family based approach Implemetatio of the Aborigial Family Health Service Guidelies Elemet 3: Culturally Competet Workforce The vulerability of Aborigial people to the risks ad effects of violece is icreased by barriers people face whe seekig support services, which is complicated by the likelihood of receivig iadequate or iappropriate resposes. It has also bee foud that Aborigial family violece programs face sigificat barriers to effective implemetatio as a result of bur out amogst staff, caused by regular dealig with costat, stress-iducig occurreces of violece i the commuity. NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 19
AFHWs provide a holistic, family based approach to supportig families dealig with issues relatig to the violece. It is also critical that maistream services provide a culturally competet service to support Aborigial cliets, recogise commuity cotext ad approaches, ad avoid treatig problems as idividualistic ad isolated. Capable, well traied ad resiliet staff will esure low staff turover, as well as a cosistecy i approach that will allow cliets to build trust with staff. A culturally competet workforce will be progressed through: Traiig ad ogoig professioal developmet Culturally competet respose traiig Orietatio ad supervisio Defied roles ad resposibilities Metorig Peer support Cliical supervisio Implemetatio of Aborigial Family Health Service Guidelies Elemet 4: Strog Commuity Capacity People live i commuities. But the real importace of "livig i commuity" is that people ad groups of people develop ways ad meas to care for each other, to urture the talets ad leadership that ehace the quality of commuity life ad to tackle the problems that threate the commuity ad udermie its potetial ad opportuities which ca help it. Whe people do these thigs, commuities become healthy; whe they do ot, commuities deteriorate. Commuities that have the ways ad meas to udertake challeges demostrate "capacity."(aspe Istitute, 1996) The Strategy recogises the potetial Aborigial commuities have to pla, maage ad implemet localised commuity based solutios that focus o the capacity for a reciprocal respose betwee the health ad well beig of a family ad the health ad well beig of commuity. Strog commuity capacity will be based o: Buildig o commuity stregths ad resiliece Recogisig, ackowledgig ad or idetifyig commuity leaders Commuity devised ad owed solutios Promotig ad sharig success Commuity developmet activities Educatio ad awareess raisig activities Social determiats of health approach A focus o healig. Healig ad the Aborigial Family Health Strategy The cocept of healig is as sigificat to the Aborigial Family Health Strategy as it is fudametal to buildig the capacity ad stregths of idividuals, families ad commuities to respod to ad recover from the trauma of family violece, sexual assault ad child abuse (Aim 2). The Aborigial Family Health Strategy ackowledges that the healig process will cotribute to urturig the spirit, the emotioal ad physical wellbeig ad cultural idetity of Aborigial idividuals ad families, which i tur will help i buildig strog ad resiliet commuities (Aim 3). Healig gives us back to ourselves. Not to hide or fight aymore. But to sit still, calm our mids, liste to the uiverse ad allow our spirits to dace o the wid. It lets us ejoy the sushie ad be bathed by the golde glow of the moo as we drift ito our dreamtime. Healig ultimately gives us back to our coutry. To stad oce agai i our rightful place, eteral ad geeratioal (Aborigial ad Torres Strait Islader Healig Foudatio Developmet Team 2009) Wester otios of healig are framed withi a medical model that primarily sees health as the absece of disease (Ustu & Jakob 2005). Priciples uderpiig a Aborigial Healig Framework are embedded i otios of holistic health ad wellbeig (Wigard & Lester 2001). The Healig Framework is dyamic ad multifaceted, i that it recogises the iterrelatioships of the spirit, the mid, the body, the physical eviromet ad culture. Sigificatly, it ecompasses the coectios ad relatioships to people, to coutry ad to Places of belogig. The healig approach places as much emphasis o the restoratio of health as o cotiuig ourishmet ad refurbishmet of people s wellbeig. Implemetatio of the Aborigial Family Health Strategy will promote a healig approach. While opportuities to do so will be supported ad icorporated ito specific actios uder the elemets of Effective Service Delivery ad Strog Commuity Capacity, healig will be a theme which uderpis the Strategy overall. PAGE 20 NSW Health NSW Aborigial Family Health Strategy 2011 2016
Me ad the Aborigial Family Health Strategy The role of Aborigial me is icreasigly recogised as vital i the work to reduce the icidece ad impact of family violece i Aborigial commuities ad is cosistet with the holistic approach to Aborigial health i geeral. Implemetatio of the Aborigial Family Health Strategy curretly ivolves specific actios such as the establishmet of additioal male AFHWs, i particular withi the Justice Health system, to work with vulerable me ad their families. I additio, while accoutig for a smaller proportio of the total, the Strategy ackowledges that me may be victims of family violece ad culturally competet ad sesitive service provisio is required. The curret scope of the Strategy excludes directly workig with perpetrators of family violece whether me or wome. AFHWs curretly implemetig the Strategy work directly with victims of family violece ad from a prevetio perspective with commuities where families are at risk. Workig with both victims ad perpetrators presets a coflict of iterest which resources for the program could ot curretly be maage. The review of the Operatioal Guidelies for Aborigial Family Health Workers (NSW Departmet of Health 2009) will address relevat issues, icludig referral processes, for workers who come ito cotact with perpetrators i the provisio of services to families. Aborigial people are determied that perpetrators of violece accept resposibility for ad the cosequeces of their actios. I a effort to maitai critical values i Aborigial culture through youger geeratios, commuities are demadig that me accept traditioal resposibilities takig resposibilities for the reworkig of spiritually strog masculie roles. Ogoig research ad evaluatio will iform future optios activity uder the Aborigial Family Health Strategy from the perspective of me as victims, perpetrators or those at risk of either. Research ad evaluatio NSW Health will cotiue to build the research ad evidece base for best practice i prevetig ad respodig to family violece i Aborigial commuities i NSW. This will take place through a rage of strategies, icludig establishig research ad evaluatio parterships with research istitutes ad researchers, as well as commissioig specific research projects. Ogoig commuicatio with orgaisatios such as the Australia Domestic ad Family Violece Clearighouse ad the Australia Child Protectio Clearighouse will esure a greater awareess of curret activity, both Australia ad iteratioal, ad icrease uderstadig of how to bridge the gap betwee research ad practice. I additio the AFHW Data Collectio will facilitate the evaluatio of the Aborigial Family Health program ad its cotributio to the Strategy as a whole. Evidece based good practice To reduce family violece i Aborigial commuities, it is essetial that LHDs ad ACCHSs develop ad deliver programs ad strategic iitiatives that are evidece based ad iformed by the best available research o what works effectively i Aborigial commuities. Commo elemets ad approaches that have bee demostrated to work well are described below. These good practices are imbedded ito the developmet of idividual actios which will be implemeted through each elemet of the Aborigial Family Health Model of Care. Commuity egagemet ad cosultatio Actively egagig local commuities i all aspects of policy, plaig, goverace ad delivery is ecessary to esure that programs are commuity owed ad resposive to local eed (Loxto et al, 2008). Extesive commuity cosultatio ad egotiatio is essetial to the success of ay program. This may iclude holdig commuity forums ad workshops ad egagig local elders ad commuity leaders. The most successful programs are those developed by ad for the commuity. Holistic focus Family violece i Aborigial commuities is iflueced by a rage of factors. These may be classified as: uderlyig factors, icludig the breakdow of traditioal social structures ad loss of idividual ad commuity idetity as a result of coloisatio situatioal factors which cotribute to the likelihood of violece for example, overcrowded ad iadequate housig, poverty, uemploymet, substace abuse, ad precipitatig causes, such as particular evets that trigger a violet episode (Memmott P et al 2001). NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 21
Program Logic Iputs Strategies Activities & Outputs Direct iputs: Develop Aborigial Family Health Service Guidelies. Aborigial Family Health Strategy: Aborigial Family Health Workers (AFHW) Aborigial Family Health Coordiators Strategic leadership Trial Aborigial Family Health Coordiator positios i three Local Health Districts (LHD). Aborigial Family Health lead perso idetified i each LHD Establish Aborigial Family Health Implemetatio Committee. Develop Aborigial Family Health Strategy Commuicatio protocols. Develop effective strategic parterships with key stakeholders. Traiig ad educatio: Traiig delivered by the Educatio Cetre Agaist Violece (ECAV). I-direct iputs: Broader system respose: Effective Service Delivery Aborigial Family Health Plas developed ad implemeted. Aborigial Family Health Actio Groups established to support implemetatio of the Strategy. Service parterships developed at both local ad regioal level. Aborigial Health Impact Statemet ad Aborigial Family Health Service Guidelies to be used as ogoig service delivery tools. Recruitmet ad traiig of ew Aborigial Family Health Workers. Maistream service provisio Aborigial Family Health Worker Operatioal Guidelies redeveloped ad implemeted. Aborigial Commuity Cotrolled Sector Other No-Govermet Orgaisatio (NGO) service provisio. Specialised family violece services. Workforce ivestmet Educatio ad traiig. Iteragecy collaboratio Culturally competet work force Support the delivery of cultural competecy traiig ad resources, icludig Competet Resposes to Aborigial Sexual Family Violece, to health service staff that work with Aborigial families. Support Aborigial Health Workers to udertake the Certificate IV Aborigial Family Violece, the Advaced Diploma i Aborigial Trauma Cousellig ad related traiig. Establish Aborigial Family Health Worker Traieeship Program. Icorporate the Aborigial Family Health Program ito the NSW Health Aborigial Workforce Developmet Strategy. Existig support: The stregth ad resiliece of Aborigial families ad commuities ad the good will ad commitmet of those workig i the area of family violece i Aborigial commuities. Strog commuity capacity Egage ad empower local Aborigial commuities i all aspects of service plaig, developmet ad delivery of solutios for family violece services. Support the delivery of commuity based educatio ad awareess programs by Aborigial Family Health Program ad related services, icludig those of ECAV. Utilise Regioal Family Health Actio Groups to share iformatio ad keep AFHWs ad health services iformed of relevat educatio, awareess ad prevetio activities i family violece. PAGE 22 NSW Health NSW Aborigial Family Health Strategy 2011 2016
Short Term Outcomes Log Term Outcomes Improved state ad regioal service coordiatio ad parterships betwee stakeholders ivolved i the respose to family violece i Aborigial commuities. Itegratio of the AFHS withi broader health system resposes to family violece. Evaluate the AFHS ad cotribute to the evidece base for best practice. Aborigial families are better protected from family violece. Decreased icidece of family violece i Aborigial commuities, icludig a reductio i the umber of Aborigial childre at risk of harm. Improved service collaboratio, coordiatio ad itegratio of service deliver betwee key stakeholders at a local ad regioal level. Improved access to culturally competet, appropriate ad resposive services for Aborigial families. Demostrated applicatio of Aborigial Family Health Service Guidelies i the desig ad delivery of accessible ad culturally appropriate programs ad services. Icreased skills ad capacity of Aborigial ad o-aborigial workforce to prevet ad respod to family violece i Aborigial commuities. Aborigial families experiecig family violece have access to effective ad culturally competet ad appropriate support services. Improved safety ad wellbeig of victims leadig to a decreased eed for more itesive itervetios Icreased capacity of Aborigial commuities to prevet ad respod to family violece. A highly skilled, supported ad culturally competet workforce able to address issues related to family violece i Aborigial commuities. Ehaced capacity of health services to deliver culturally appropriate ad holistic services to prevet ad respod to family violece i Aborigial commuities. Icrease the skills of the Aborigial Family Health workforce through the creatio of further career developmet opportuities ad pathways. Developmet of a log term workforce strategy for workers respodig to family violece i Aborigial commuities Reduced tolerace of family violece i Aborigial commuities. Aborigial commuities where victims of family violece are safe ad supported i seekig help. Icreased capacity of health services to deliver resposes to family violece that have commuity owership ad are resposive to local eed. Icreased kowledge, skills ad capacity of Aborigial commuities to prevet ad respod to family violece. Ehaced skills of Aborigial ad o-aborigial workforce, ad those of commuity members to facilitate educatio ad commuity developmet programs that prevet ad respod to family violece. NSW Aborigial Family Health Strategy 2011 2016 NSW Health PAGE 23