Academic literature on the topic 'Aboriginal and Torres Strait Islander psychology'

The Aboriginal and Torres Strait Islander Child Placement Principle has been the policy guiding the placement of indigenous children in most Australian child protection jurisdictions for around fifteen years. The Principle requires the involvement of Aboriginal and Torres Strait Islander community representatives in decision making concerning indigenous children, and ensuring that alternative care placements of Aboriginal and Torres Strait Islander children are with Aboriginal and Torres Strait Islander careproviders.Most Jurisdictions still have a significant number of Aboriginal and Torres Strait Islander children placed with non-indigenous careproviders, and community based Aboriginal and Islander child care agencies continue to express dissatisfaction about the nature and level of consultation which occurs when welfare departments are taking action to protect indigenous children.This paper, which was presented at the IFCO conference in Melbourne in July 1999, examines why there has been such limited improvement in Child Placement Principle outcomes. Work undertaken in Queensland to address the over representation of Aboriginal and Torres Strait Islander children in the child protection system will be outlined from both a departmental and community perspective. The paper argues that if strategies for addressing these issues are not located within a framework of self determination for Aboriginal and Torres Strait Islander people, then they will not work.

DEMONSTRATING PERSISTENCE and resilience, increasing numbers of Aboriginal and Torres Strait Islander early childhood teachers are gaining university qualifications. This paper explores factors that support and constrain these students on the path to their degrees. Investigated through a cycle of interviews and focus groups, otherwise perceived as taking time to chat and yarn, the data speaks through Aboriginal and Torres Strait Islander voices. Graduates from a cohort-specific three-year degree program, and several of their colleagues from an earlier program, share their reflections. The importance of family, community and infrastructure support is apparent, as well as recognition of complexities of ‘both ways’ learning (Hughes, Fleet & Nicholls, 2003) and cultural boundary crossing (Giroux, 2005). Highlighting salient factors is critical in efforts to create and maintain conditions in which Aboriginal and Torres Strait Islanders can gain university qualiflcations and extend their professional contributions.

Aboriginal and Torres Strait Islander people with autism spectrum disorder, used interchangeably with the term autism, are among the most marginalised people in Australian society. This review maps out existing and emerging themes in the research involving Indigenous Australians with autism based on a search of the peer-reviewed and grey literature. Our search identified 1457 potentially relevant publications. Of these, 19 publications met our inclusion criteria and focused on autism spectrum disorder diagnosis and prevalence, as well as carer and service provider perspectives on autism, and autism support services for Indigenous Australians. We were able to access 17 publications: 12 journal articles, 3 conference presentations, 1 resource booklet and 1 dissertation. Findings suggest similar prevalence rates for autism among Indigenous and non-Indigenous Australians, although some Aboriginal and Torres Strait Islander people with autism may not receive a diagnosis or may be misdiagnosed. Research on the perspectives of Aboriginal and Torres Strait Islander carers and Indigenous and non-Indigenous service providers is discussed in relation to Indigenous perspectives on autism, as well as barriers and strategies to improve access to diagnosis and support services. Although not the focus of our review, we briefly mention studies of Indigenous people with autism in countries other than Australia. Lay Abstract Aboriginal and Torres Strait Islander people with developmental disabilities such as autism are among the most marginalised people in Australian society. We reviewed research involving Indigenous Australians with autism based on a search of the peer-reviewed and grey literature. Our search identified 1457 potentially relevant publications. Of these, 19 publications were in line with our main areas of inquiry: autism spectrum disorder diagnosis and prevalence, carer and service provider perspectives on autism, and autism support services. These included 12 journal publications, 3 conference presentations, 1 resource booklet and 1 thesis dissertation. Findings suggest similar prevalence rates for autism among Indigenous and non-Indigenous Australians, although some Aboriginal and Torres Strait Islander people with autism may not receive a diagnosis or may be misdiagnosed. We also discuss research on the perspectives of Aboriginal and Torres Strait Islander carers and Indigenous and non-Indigenous service providers, as well as barriers and strategies for improving access to diagnosis and support services.

This is the first qualitative study to investigate experiences of, and attitudes towards, autism in Aboriginal and Torres Strait Islander communities in Australia. Understanding the complexity of these attitudes is crucial because they influence the recognition of autism as well as the ways in which individuals and families are supported. Twelve families with 16 autistic children living in diverse regions of Australia participated in a semi-structured interview. The interviews were thematically analysed using the six-step process outlined by Braun and Clarke. The analysis identified a marked tension in participants’ accounts. On the one hand, participants described negative feelings, including shame associated with atypical behaviour, stigmatisation and the social isolation of families, which potentially point towards under-identification or misdiagnosis. On the other hand, they also described inclusive attitudes, including ‘looking after each other’ and a growing acceptance of autistic differences. This positive model of support for and acceptance of autistic children and their families may well contribute to good outcomes for autistic children and adults in Aboriginal and Torres Strait Islander communities. More research is needed on cross-cultural and pluralistic understandings of autism, parental perceptions and family experience. Lay Abstract There has been almost no research done about autism in Aboriginal and Torres Strait Islander communities in Australia. This article is the first detailed report on attitudes to autism in these communities. Understanding attitudes to autism is important because they influence whether or not children are diagnosed, as well as the kinds of support autistic people are getting. Twelve families who lived in different parts of Australia were interviewed. They told us that there is a range of attitudes to autism in Aboriginal and Torres Strait Islander communities. These include negative ideas such as sometimes feeling shame associated with children’s unusual behaviour, as well as feeling stigmatised and socially isolated. The negative attitudes reported may mean that some children are missing out on an autism diagnosis or being wrongly diagnosed with a different condition in these communities. They also included positive ideas such as the importance of looking after each other and of accepting autistic people and their differences. We can all learn from these positive attitudes. It will be interesting to know in future projects whether these accepting attitudes lead to better outcomes for autistic children and adults in these communities. This research helps us to understand how autism is thought about in different cultures and how attitudes impact diagnosis and support. It will also help people to plan supports that reflect what Aboriginal and Torres Strait Islander families actually want and need.

This paper will address the overall approach of the present government to the provision of Aboriginal children's services in the context of the social indicators about Aboriginal children within Aboriginal society and non-Aboriginal society. It will then outline the proper and appropriate frameworks for the development of services for Aboriginal children.

Objective Health practitioners’ Codes of Conduct and Codes of Ethics articulate practice standards across multiple domains, including the domain of cultural safety. As key tools driving individual practice and systems reform, Codes are integral to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It is, therefore, critical that their contents specify meaningful cultural safety standards as the norm for institutional and individual practice. This research assessed all Codes for cultural safety specific content. MethodsFollowing the release of the Australian Health Practitioner Regulation Agency’s (Ahpra) Health and Cultural Safety strategy 2020–25, the 16 Ahpra registered health practitioner Board Codes of Conduct and professional Codes of Ethics were analysed by comparing content to Ahpra’s new cultural safety objectives. Two Codes of Conduct, Nursing and Midwifery, met these objectives. The Aboriginal and Torres Strait Islander Health Practitioners Code partially met these objectives. ResultsMost Codes of Conduct (14 of 16) conflated Aboriginal and Torres Strait Islander peoples with culturally and linguistically diverse (CALD) communities undermining the sovereignty of Australia’s First Peoples. Eleven professions had a Code of Ethics, including the Physiotherapy Code of Conduct, which outlined the values and ethical principles of practice commonly associated with a Code of Ethics. Of the 11 professions with a Code of Ethics, two (Pharmacy and Psychology) articulated specific ethical responsibilities to First Peoples. Physiotherapy separately outlined cultural safety obligations through their reconciliation action plan (RAP), meeting all Ahpra cultural safety objectives. The remaining eight advocated respect of culture generally rather than respect for Aboriginal and Torres Strait Islander cultures specifically. ConclusionsThe review identified multiple areas to improve the codes for cultural safety content for registered health professions, providing a roadmap for action to strengthen individual and systems practice while setting a clear regulatory standard to ensure culturally safe practice becomes the new norm. It recommends the systematic updating of all professional health practitioner Board Codes of Conduct and professional Codes of Ethics based on the objectives outlined in Ahpra’s Cultural Safety Strategy. What is known about the topic?Systemic racism and culturally unsafe work environments contribute to poor health outcomes for Aboriginal and Torres Strait Islander peoples. They also contribute to the under-representation of Aboriginal and Torres Strait Islander peoples in the health workforce, denying the system, and the people who use and work in it, much needed Indigenous knowledge. Creating a culturally safe healthcare system requires all health practitioners to reflect on their own cultural background, to gain appreciation of the positive and negative impacts of individually held cultural assumptions on the delivery of healthcare services. Competence in cultural safety as a required standard of practice is therefore essential if broad, sustainable and systemic cultural change across the health professions and ultimately across Australia’s healthcare system is to be achieved. Given that Codes of Conduct and Codes of Ethics are integral in setting the practical and moral standards of the professions, their contents with respect to cultural competence are of great importance. What does this paper add?A review of this type has not been undertaken previously. Following the establishment of the Ahpra Aboriginal and Torres Strait Islander Health Strategy Group, release of Ahpra’s 2018 Statement of intent, and the 2019 Aboriginal and Torres Strait Islander Health and Cultural Safety strategic plan and Reconciliation Action Plan, we analysed the content of each of the 16 registered health professions Codes of Conduct and Code of Ethics looking for content and guidance in accordance with the new national cultural safety definition. Several opportunities to improve the Codes of Conduct and Codes of Ethics were identified to realise the vision set out in the statement of intent including through the application of the National Law. This analysis provides a baseline for future improvements and confirms that although some current health practitioner Codes of Conduct and Codes of Ethics have begun the journey of recognising the importance of cultural safety in ensuring good health outcomes for Australia’s Indigenous peoples, there is broad scope for change. What are the implications for practitioners?The gaps identified in this analysis provide a roadmap for improvement and inclusion of Aboriginal and Torres Strait Islander Health and cultural safety as a required standard in Codes of Conduct and Codes of Ethics for all registered health practitioners. Although it is recognised that Codes alone may not change hearts and minds, codifying the clinical competency of cultural safety provides a portal, and a requirement, for each individual practitioner to engage meaningfully and take responsibility to improve practice individually and organisationally.

Existing research has explored inclusion in education, however, issues related to Aboriginal and Torres Strait Islander LGBTIQ+ young people, with some notable exceptions, have, until recently, seldom been included in any meaningful academic discussion. Issues of youth race, gender and sexuality have been interrogated as discrete issues. This small but growing body of research demonstrates the potential impacts of intersectional disadvantages experienced by Aboriginal and Torres Strait Islander LGBTIQ+ young people in Australia (Uink, Liddelow-Hunt, Daglas, & Ducasse, 2020). This article seeks to explore the existing research and advocate for the embedding of a critical pedagogy of care in primary Initial Teacher Education (ITE) curricula, inclusive of diversity of race, ethnicity, socio-economic-status, gender and sexuality. Employing intersectionality theory, this research will examine the specific disadvantages that arise as the result of occupying multiple minority demographic categories, which are relational, complex and shifting, rather than fixed and independent. Primary educators are well positioned to name disadvantage, racism and heterosexism, make them visible and, through culturally responsive pedagogical approaches and inclusive curricula, challenge the status quo. To ensure that learning and teaching moves beyond stereotypes, primary curricula should be representative of all students and present alternate ways of being human in culturally appropriate, positive ways, to the benefit of all students. ITE programs provide the ideal arena to equip teachers with the knowledge and competency to respond to the needs of Aboriginal and Torres Strait Islander LGBTIQ+ young people.

Aboriginal youth are overrepresented within Victoria’s criminal justice system (Cunneen, 2020). Aboriginal and Torres Strait Islander youth are diverse people with diverse needs: It is imperative to understand what those needs are and how they can be supported within Victoria’s youth justice centres. Research has identified that Aboriginal youth in Victoria’s justice system have higher rates of psychopathology (Shepherd et al., 2018), higher rates of recidivism (Cunneen, 2008), higher pre-custody rates and post-release rates of substance abuse (Joudo, 2008) and lower rates of rehabilitation (Thompson et al., 2014) than non-Indigenous counterparts. It is critical to explore how the Victorian youth justice system identifies and implements the provision of services that consider lesbian, gay, bisexual, transgender, intersex, queer, sistergirl and brotherboy (LGBTIQSB+) identities of Aboriginal youth in custody. This is because additional levels of systemic disadvantage, discrimination, stigma, and social exclusion that impact LGBTIQ+ youth specifically (Cunneen, Goldson, & Russell, 2016) as well as Aboriginal identity, further compound and jeopardize the social and emotional wellbeing of those embodying intersectional identities. This article will examine the services available to Aboriginal LGBTIQSB+ youth in the Victorian criminal justice system. Aboriginal, Torres Strait Islander, Indigenous and First Nations People will be used interchangeably throughout this document.

Colonisation in Australia has had a devastating and lasting impact on the wellbeing of Aboriginal and Torres Strait Islander peoples in Australia (herein referred to as Indigenous Australians). This paper discusses the role of psychology in Australia and the negative impact that certain disciplinary theories and practices have had on Indigenous Australians. The impact has been further exacerbated by the failure of mainstream policy makers and mental health practitioners to recognise the key, distinctive cultural and social determinants that contribute to Aboriginal health and wellbeing. There is a growing response by Aboriginal psychologists, critical social theorists, and their allies to decolonise psychological theory and practice to redress this situation. This paper outlines key decolonising strategies that have been effective in interrupting those aspects of psychology that are inimical to Aboriginal wellbeing.

This thesis is the first to comprehensively evaluate Acute Respiratory Illness with Cough (ARIwC) in urban, predominantly Aboriginal and Torres Strait Islander, children. It identified a community experiencing significant disadvantage and a concerning burden of ARIwC. Positive findings include the frequent presentation to primary health care, continuity of primary health care provider, and knowledge of when cough is abnormal; factors that are all critical to the success of interventions and further research to reduce the burden of disease.

Thesis (Master of Letters)--Central Queensland University, 1998.
"A dissertation submitted in partial fulfilment of the requirements for the Degree of Letters in History. Central Queensland University." Cover title.

Compared to males in almost any social group in all affluent nations, Australia's Aboriginal and Torres Strait Islander men suffer from substantially more serious illnesses and early death. To date, research done by or in collaboration with Indigenous communities has revealed the extent of the problems that arise from diabetes, heart disease, hypertension, cancers, respiratory diseases, psychological disorders, accidental injuries, violence and other causes. Reproductive health, however, rarely has been studied among Indigenous men. To date, research in this field has been limited mainly to studies of sexually transmitted infections. No data has been published on Aboriginal men's symptoms of prostate disease or erectile dysfunction, nor has the clinical screening and treatment of these disorders among these men been assessed. In-depth search of the worldwide web demonstrated that little information on these issues was available from other Indigenous populations. It does appear that Indigenous men in Australia, New Zealand and North America are less likely than European-ancestry men to die from prostate cancer, or for living cases to be recorded on cancer registries. This may arise because Indigenous men genuinely have a lower risk, or because they are not captured by official statistics, or because they do not live long enough to develop severe prostate disease. We also know very little about other reproductive health problems such as sexual dysfunction and specifically erectile difficulties. One reason for our scant knowledge is that research mainly relies on self-report of sensitive information. The aim of the research study was to improve the understanding of sexual and reproductive health problems experienced by Indigenous men. This is best gathered by Aboriginal males who are inside the culture of middleaged and older Indigenous men, but until now this has not been attempted. In this study we adopted the World Health Organization (WHO) definitions for Reproductive and Sexual Health (WHO, 2001). Thus, we consider reproductive system disorders (prostate disease, erectile dysfunction) and related health care-seeking, and also men's perceptions about a "satisfying and safe sexual life". The methodology was framed within an Aboriginal and Torres Strait Islander research protocol that advocates respect for cultural, social and community customs. A mixed method design combined qualitative inquiry (4 focus groups and 18 in-depth interviews) and quantitative survey (n=301) involving men living in remote, rural and urban communities (Tiwi Islands, Darwin and north and south-east Queensland). Survey data were compared to recently published self-reports from 5990 randomly selected men aged over 40 years in Australia (Holden et al., 2005, The Lancet, 366, 218-224. The qualitative interviews revealed that most men were silent about reproductive health. They were unwilling to reveal their inner feelings to wives or partners, and they were unwilling to discuss such issues with doctors and other health care workers. Men's reaction to sexual difficulties included shame, denial, substance abuse and occasionally violence. On a positive note many men said they want to learn about it, so they understand how to cope with such problems. The Indigenous men reported symptoms of erectile dysfunction at least as much as non-Indigenous men in other Australian studies. Bivariate analysis showed that erectile dysfunction was correlated with many health and lifestyle variable. However multivariate analysis revealed that only three factors significantly predicted ED: presence of chronic disease, presence of pain when working, and living in a remote geographic location The quantitative survey data indicate that Indigenous men have more symptoms of prostate disease than non-Indigenous men. The syndrome appears to be poorly managed in clinical practice (e.g. rates of PSA testing and digital-rectal examination are only one-third the rate reported by non-Aboriginal men, despite equivalent likelihood of GP visits). The research study adds to the literature by providing better insight and depth into the issues impacting on Aboriginal and Torres Strait Islander males experiencing reproductive and sexual health difficulties. It also provides a platform to undertake comprehensive research with Aboriginal and Torres Strait Islander men to explore a wider spectrum of questions in this important but neglected area. Implications for education of primary healthcare workers and community-based awareness campaigns for Indigenous males are discussed. Most of all, this study revealed "layers" of silence around sexual and reproductive health of Indigenous men. This includes silence in the scientific establishments in health services, and in the community. It is hoped that this study puts the voices of the men forward to help to break down this silence.

Compared to males in almost any social group in all affluent nations, Australia's Aboriginal and Torres Strait Islander men suffer from substantially more serious illnesses and early death. To date, research done by or in collaboration with Indigenous communities has revealed the extent of the problems that arise from diabetes, heart disease, hypertension, cancers, respiratory diseases, psychological disorders, accidental injuries, violence and other causes. Reproductive health, however, rarely has been studied among Indigenous men. To date, research in this field has been limited mainly to studies of sexually transmitted infections. No data has been published on Aboriginal men's symptoms of prostate disease or erectile dysfunction, nor has the clinical screening and treatment of these disorders among these men been assessed. In-depth search of the worldwide web demonstrated that little information on these issues was available from other Indigenous populations. It does appear that Indigenous men in Australia, New Zealand and North America are less likely than European-ancestry men to die from prostate cancer, or for living cases to be recorded on cancer registries. This may arise because Indigenous men genuinely have a lower risk, or because they are not captured by official statistics, or because they do not live long enough to develop severe prostate disease. We also know very little about other reproductive health problems such as sexual dysfunction and specifically erectile difficulties. One reason for our scant knowledge is that research mainly relies on self-report of sensitive information. The aim of the research study was to improve the understanding of sexual and reproductive health problems experienced by Indigenous men. This is best gathered by Aboriginal males who are inside the culture of middleaged and older Indigenous men, but until now this has not been attempted. In this study we adopted the World Health Organization (WHO) definitions for Reproductive and Sexual Health (WHO, 2001). Thus, we consider reproductive system disorders (prostate disease, erectile dysfunction) and related health care-seeking, and also men's perceptions about a "satisfying and safe sexual life". The methodology was framed within an Aboriginal and Torres Strait Islander research protocol that advocates respect for cultural, social and community customs. A mixed method design combined qualitative inquiry (4 focus groups and 18 in-depth interviews) and quantitative survey (n=301) involving men living in remote, rural and urban communities (Tiwi Islands, Darwin and north and south-east Queensland). Survey data were compared to recently published self-reports from 5990 randomly selected men aged over 40 years in Australia (Holden et al., 2005, The Lancet, 366, 218-224. The qualitative interviews revealed that most men were silent about reproductive health. They were unwilling to reveal their inner feelings to wives or partners, and they were unwilling to discuss such issues with doctors and other health care workers. Men's reaction to sexual difficulties included shame, denial, substance abuse and occasionally violence. On a positive note many men said they want to learn about it, so they understand how to cope with such problems. The Indigenous men reported symptoms of erectile dysfunction at least as much as non-Indigenous men in other Australian studies. Bivariate analysis showed that erectile dysfunction was correlated with many health and lifestyle variable. However multivariate analysis revealed that only three factors significantly predicted ED: presence of chronic disease, presence of pain when working, and living in a remote geographic location The quantitative survey data indicate that Indigenous men have more symptoms of prostate disease than non-Indigenous men. The syndrome appears to be poorly managed in clinical practice (e.g. rates of PSA testing and digital-rectal examination are only one-third the rate reported by non-Aboriginal men, despite equivalent likelihood of GP visits). The research study adds to the literature by providing better insight and depth into the issues impacting on Aboriginal and Torres Strait Islander males experiencing reproductive and sexual health difficulties. It also provides a platform to undertake comprehensive research with Aboriginal and Torres Strait Islander men to explore a wider spectrum of questions in this important but neglected area. Implications for education of primary healthcare workers and community-based awareness campaigns for Indigenous males are discussed. Most of all, this study revealed "layers" of silence around sexual and reproductive health of Indigenous men. This includes silence in the scientific establishments in health services, and in the community. It is hoped that this study puts the voices of the men forward to help to break down this silence.

During 1987 my essential beliefs about the nature of the world were challenged by a chance event which led to my arrival in Arnhemland. Working with Aboriginal people allowed me to see first hand the failings of Western ideas in Aboriginal education and health. This is how a 12 year collaboration with Aboriginal people began. The aim was to search for answers to the question, 'Why so many ideas that had been successfully used in the Western world, fail to meet the needs of aboriginal people? My experiences prior to 1995 had led me to believe that Both Ways, an education pedagogy developed in teacher education, was the best approach for empowering Aboriginal Health Workers. I believed Both Ways gave Aboriginal Health Workers a means to develop solutions to aboriginal health issues which valued and respected their aboriginal knowledge. I needed to describe and evaluate the practice of both ways with Aboriginal Health workers for the purpose of proving the benefit of this pedagogy for other educators in this field. This thesis describes how I came to think Both Ways was a good idea; how I defined Both ways; and how I put it into practice. It also provides a description of the issues raised in my critique of Both Ways and in my attempts to provide answers to these issues. Several years of collecting data, including records from action research group discussions, participant observation, interviews with peers and students, and formal evaluations left me with many concerns about Both Ways. As educators follow my journey of discovery I hope that they will recognise experiences and insights that they themselves have shared. The descriptions and discussions in this thesis will add significantly to the overall discourse about health worker education. Similarly, the exploration of ideas beyond Both Ways will add significantly to the overall body knowledge about the power relationships involved in teaching in a cross cultural setting
Doctor of Philosophy (PhD)

This study involves the analysis of one of the most recent Indigenous Education policies, the Aboriginal and Torres Strait Islander Education Action Plan 2010-2014 (MCEECDYA, 2011). It examines how the language used within policy positions Aboriginal and Torres Strait Islander peoples. Articulating Rigney's (1999) Indigenist Research Principles with Fairclough's (2001) Critical Discourse Analysis provides a platform for critical dialogues about policy decision-making. In doing so, this articulation enables and emphasises the need for potential policy revision to contribute to the Aboriginal and Torres Strait Islander struggle for self-determination.

This thesis explored how six teachers of mathematics embedded Aboriginal and Torres Strait Islander Peoples’ Histories and Cultures into the core mathematics curriculum. Semi-structured interviews were conducted, then written transcripts were analysed through the use of Bernstein’s Theory of Pedagogic Discourse. Teachers shared their perspectives on how they have developed their cultural capabilities, and how this has informed culturally responsive teaching of mathematics. Recommendations are made for how to support in-service teachers with their personal cultural capabilities to authentically embed Aboriginal and Torres Strait Islander Peoples’ Histories and Cultures in mathematics curriculum.

The pervasive health and social disadvantage faced by Aboriginal and Torres Strait Islander peoples is an acknowledged part of Australian society. The contemporary data reveal striking inequalities between Indigenous and non-Indigenous Australians in most measurable aspects of wellbeing across the life cycle. This reflects a postcolonial history of marginalisation and exclusion from mainstream society, dispossession of traditional lands, forced separation from family and kinship networks, and racism. Despite an increased awareness and disapproval of these inequalities in health, the inequalities persist.The lack of progress in the face of public disapproval and progressive government support underscores the fact that we still do not adequately understand the fundamental causes of Indigenous ill health and disease. A small body of research in Australia has highlighted that socioeconomic status (SES) accounts for a portion of the gap in health but this does not imply that they account for health differences within Indigenous population groups. A robust international literature has consistently shown that socioeconomic factors influence population health. These factors reflect the way in which society is ordered according to wealth, prestige, power, social standing or one’s control over economic resources, and their pattern of association with health has almost always depicted better health for those who are better off— that is, the health of population groups normally follows a gradient pattern. Despite the ubiquity of this observation in the empirical literature, there is uncertainty as to whether it applies to Aboriginal and Torres Strait Islander populations in Australia.Accordingly, this thesis has aimed to assess the pattern of socioeconomic disparities in the health and development of Indigenous populations in Australia, with a specific focus on children. The three key objectives were to: • Describe the developmental status of Indigenous children and the mechanisms that influence this status; • Determine the pattern of association between socioeconomic factors and physical and mental health outcomes; and • Reveal the significant differences (and similarities) in the socioeconomic pattern of child health between Indigenous and non-Indigenous populations, and articulate these in terms of their direction, shape and magnitude.The objectives of the study were primarily assessed using a quantitative analytic framework applied to four existing population-representative datasets: the 2008 National Aboriginal and Torres Strait Islander Social Survey, the 2000–2002 Western Australian Aboriginal Child Health Survey, the 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey. Simple univariate and cross-tabulation data were used to describe population characteristics, while the relationships between socioeconomic indicators and health outcomes were assessed using a range of regression techniques. Multilevel models are an important feature of this study, and have enabled a more accurate estimation of the effects of individual and area-level measures of SES on health. Generalised Additive Models were used to account for the possible non-linear nature of associations between continuous SES variables and physical health outcomes, with results presented as non-parametric spline curves. The mechanisms linking SES and mental health were explored using a stepwise approach to the regression analysis. All data in all chapters were weighted to reflect population benchmarks.The findings highlighted that there were significant socioeconomic disparities in the health of Indigenous children in Australia, although the direction, shape and magnitude varied, by both socioeconomic measure and health outcome. While the socioeconomic patterns of Indigenous child health are not universal, they are more consistent for mental than physical health. In addition, the thesis has shown that both conventional and alternative notions of SES can influence health patterns. The largest disparities in child physical health were observed for area-level SES indicators, while housing characteristics and area-level SES both had a strong direct effect on child mental health.The thesis has demonstrated that the patterns of socioeconomic disparities in child health differ markedly in Indigenous and non-Indigenous populations—at least in non-remote settings. It was not uncommon for the magnitude of disparity to be larger in the Indigenous population. These findings lend support to the notion that socioeconomic factors have a differential impact on the health of Indigenous and non-Indigenous populations. The implication of this for policy is that a single approach to stimulating socioeconomic conditions will not have equal benefits to child health outcomes in Indigenous and non-Indigenous populations. While the evidence here underscores the validity of the well-worn edict that “one size does not fit all” in Indigenous health policy, it also reinforces the need to examine health disparities within and across Indigenous and other population groups in order to better inform policy and practiceCollectively, the results have provided clear evidence that socioeconomic factors matter to both the physical and mental health of Aboriginal and Torres Strait Islander children. The diversity of findings implies that SES factors are one facet of the unique and complex set of factors that influence Aboriginal child health and wellbeing.This thesis has made several original contributions to the literature on social inequalities in Indigenous health in Australia and the broader field of social determinants of health. It is one of the few studies internationally to explicitly look at the socioeconomic patterning of health in an Indigenous population, and the first to examine these patterns among Indigenous children using population-representative data. In doing so, the study has begun to bridge the knowledge gap on social inequalities in Aboriginal health in Australia, and will facilitate a better grasp of the complex underlying mechanisms that determine Aboriginal health.For policy, this knowledge can lead to more effective government decision-making in terms of targeting social determinants of health that are of particular significance for Aboriginal populations. It is hoped that the findings of the thesis can provide directions for future research and insights to policy that will, ultimately, increase the pace of change toward health equity in Australia.

This thesis focuses on non-Indigenous educators’ work around embedding Indigenous perspectives in early childhood education curricula. In place of reporting examples of ‘good’ educational practice, the study questions how whiteness and racism continue to operate in diversity work that is seen to be productive and inclusive. The thesis argues for a more comprehensive framework for embedding Indigenous perspectives in before-school contexts to support educators’ efforts. New strategies for professional development are also suggested to support changes in disciplinary knowledge and pedagogy.

"Many Australian universities have recently incorporated Indigenous graduate attributes into their programs, and the University of Technology Sydney (UTS) is no exception. This project aimed to investigate students’ perceptions and experiences of learning about Indigenous Knowledge systems and culture while developing science communication skills. Advanced Communication Skills in Science is a core subject in the Master of Science program at UTS. An existing assessment task, a three-minute thesis style oral presentation, was reworked to include the Indigenous Graduate Attribute (IGA) developed for the Faculty of Science. Students researched an aspect of Indigenous Science, an area of emerging interest for cultural and scientific understanding, and a mechanism for empowering Australia’s diverse first nations peoples. They then presented their key message in three minutes using a single PowerPoint slide. This task allowed students to demonstrate an awareness and appreciation of multiple ways of developing understandings of nature while enhancing their ability to understand the role of science communication in the modern world. Students were surveyed at the beginning and end of the semester to establish their Indigenous Science conceptions and reflect on their experiences. Students demonstrated an outstanding ability to integrate appropriate Aboriginal and Torres Strait Islander knowledges, experience, and analysis into a key message. Most students reported greater familiarity with concepts such as Indigenous Science and provided richer definitions of what this means. When asked if understanding Aboriginal and Torres Strait Islander knowledges and cultural practices might impact their practice as a scientist, many felt their perspective had changed and that reflecting on their cultural values and beliefs had improved their cultural capability. Most students responded that this subject challenged (at least to a degree) some firmly held assumptions, ideas, and beliefs."

The Longitudinal Study of Indigenous Children (LSIC; also called Footprints in Time) is the only longitudinal study of developmental outcomes for Aboriginal and Torres Strait Islander children globally. Footprints in Time follows the development of Australian Aboriginal and Torres Strait Islander children to understand what Indigenous children need to grow up strong. LSIC involves annual waves of data collection (commenced in 2008) and follows approximately 1,700 Aboriginal and Torres Strait Islander children living in urban, regional, and remote locations. This LSIC Primary School report has been produced following the release of the twelfth wave of data collection, with the majority of LSIC children having completed primary school (Preparatory [aged ~5 years] to Year 6 [aged ~12 years]). Primary schools play a central role in supporting student learning, wellbeing, and connectedness, and the Footprints in Time study provides a platform for centring Indigenous voices, connecting stories, and exploring emerging themes related to the experience of Indigenous children and families in the Australian education system. This report uses a mixed-methods approach, analysing both quantitative and qualitative data shared by LSIC participants, to explore primary school experiences from the perspective of children, parents and teachers. Analyses are framed using a strengths-based approach and are underpinned by the understanding that all aspects of life are related. The report documents a range of topics including teacher cultural competence, racism, school-based Aboriginal and Torres Strait Islander education activities, parental involvement, engagement, attendance, and academic achievement.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.