Articoli di riviste sul tema "Aboriginal and Torres Strait Islander social impact and program evaluation"

Objectives The aim of the study was to assess the utility of national Aboriginal survey data in a regional geospatial analysis of daily smoking prevalence for Aboriginal and Torres Strait Islander Australians and discuss the appropriateness of this analysis for policy and program impact assessment. Methods Data from the last two Australian Bureau of Statistics (ABS) national surveys of Aboriginal and Torres Strait Islander people, the National Aboriginal and Torres Strait Islander Social Survey 2014–15 (n = 7022 adults) and the National Aboriginal and Torres Strait Islander Health Survey 2012–13 (n = 10 896 adults), were used to map the prevalence of smoking by Indigenous regions. Results Daily smoking prevalence in 2014–15 at Indigenous regions ranges from 27.1% (95%CI 18.9–35.3) in the Toowoomba region in Queensland to 68.0% (95%CI 58.1–77.9) in the Katherine region in the Northern Territory. The confidence intervals are wide and there is no significant difference in daily smoking prevalence between the two time periods for any region. Conclusion There are significant limitations with analysing national survey data at finer geographical scales. Given the national program for Indigenous tobacco control is a regional model, evaluation requires finer geographical analysis of smoking prevalence to inform public health progress, policy and program effects. Options to improve the data currently collected include increasing national survey sample sizes, implementing a smoking status question in census surveys, investing in current cohort studies focused on this population or implementing localised surveys. What is known about the topic? The last geospatial analysis of Aboriginal and Torres Strait Islander smoking prevalence was undertaken in 1997. Current national survey data have not been analysed geospatially. What does this paper add? This paper provides new insights into the use of national survey data for understanding regional patterns and prevalence levels of smoking in Aboriginal and Torres Strait Islander populations. What are the implications for practitioners? The findings of the study suggest caution when interpreting prevalence maps and highlight the need for greater sample sizes in national survey data. The analysis is also an opportunity to assess the use of national survey data in evaluating the policy impact of programs targeted at a regional level.

Aim: This paper discusses the current mental health and social and emotional wellbeing in Indigenous Australian mental health and wellbeing, the gaps in research, the need for transformative and decolonising research and practice, and the opportunities and recommendations to address existing mental health inequities. Method: This paper reviews key mental health and social and wellbeing policy documents and frameworks, and examines relevant literature documenting current decolonising strategies to improve programs, services and practice. It also draws on the key findings of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) and Transforming Indigenous Mental Health and Wellbeing research projects. In addition this work builds on the substantial work of the national Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) which outlines a range of solutions to reduce the causes, prevalence, and impact of Indigenous suicide by identifying, translating, and promoting the adoption of evidenced based best practice in Indigenous specific suicide prevention activities. Discussion and Conclusion: This paper details the challenges as well as the promise and potential of engaging in transformative and decolonising research and practice to address the existing health service inequities. Acknowledging and addressing these health inequities is an urgent and critical task given the current COVID-19 pandemic and potential for further increasing the adverse mental health and wellbeing gap for Indigenous Australians.

Background Chronic diseases account for over 70% of health gaps between Aboriginal people and the rest of the Australian population. The 1 Deadly Step program involves community-based events that use a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW). Objective This study aimed to evaluate the feasibility and acceptability of a community-based chronic disease screening program for Aboriginal people. Methods In 2015, the program was enhanced to include an iPad app for screening assessments, a results portal for nominated care providers, and a reporting portal for program administrators and implemented in 9 NSW community events. A mixed methods evaluation comprising survey data, analytics obtained from iPad and Web portal usage, and key informant interviews was conducted. Results Overall, 1046 people were screened between April 2015 and April 2016 (mean age 40.3 years, 640 (61.19%) female, 957 (91.49%) Aboriginal or Torres Strait Islander). High chronic disease rates were observed (231 [22.08%] participants at high cardiovascular disease (CVD) risk, 173 [16.54%] with diabetes, and 181 [17.30%] with albuminuria). A minority at high risk of CVD (99/231 [42.9%]) and with diabetes (73/173 [42.2%]) were meeting guideline-recommended management goals. Overall, 297 participants completed surveys (response rate 37.4%) with 85.1% reporting satisfaction with event organization and information gained and 6.1% experiencing problems with certain screening activities. Furthermore, 21 interviews were conducted. A strong local working group and processes that harnessed community social networks were key to implementation success. Although software enhancements facilitated screening and data management, some technical difficulties (eg, time delays in processing blood test results) impeded smooth processing of information. Only 51.43% of participants had a medical review recorded postevent with wide intersite variability (10.5%-85.6%). Factors associated with successful follow-up included clinic managers with overall program responsibility and availability of medical staff for immediate discussion of results on event day. The program was considered highly resource intensive to implement and support from a central coordinating body and integration with existing operational processes was essential. Conclusions 1 Deadly Step offers an effective and acceptable strategy to engage Aboriginal communities in chronic disease screening. High rates of risk factors and management gaps were encountered, including people with no previous knowledge of these issues. Strategies to improve linkage to primary care could enhance the program’s impact on reducing chronic disease burden.

Health inequity and unjust access to care and a higher burden of chronic disease persist in Australia for Aboriginal and Torres Strait Islander (respectfully Indigenous) peoples. For example, in 2015 -2017, compared with non-Indigenous people, Indigenous people had 3.1 times higher rate of in hospitalisation, 4.7 times higher rate of Discharge Against Medical Advice, and almost three times the rate of Potentially Preventable Hospitalisations. These are significant measures of healthcare inequity that highlight the lack of an integrated care model for Indigenous people. Hospital in the Home (HITH) has been a successful integrated care model globally. There is an extensive international research base, including a meta-analysis of 61 randomised control trials, as well as growing experience in Australia. The demonstrated beneficial impact of HITH programs includes equal or better patient clinical outcomes, higher patient satisfaction, reduced hospital admission and re-admissions and reduced overall costs. Despite recognising the inequities in health outcomes for Indigenous people, there has been no published report of Indigenous-specific models of HITH in Australia. Culturally safe health services which address potential institutional barriers to acute inpatient care can improve Indigenous peoples’ access to and the quality of integrated health care. An Indigenous HITH program (I-HITH) will integrate the models of care between secondary and primary care sectors, aiming to improve care outcomes of Indigenous people, via bringing acute care, and the management of acute exacerbations of chronic conditions, closer to home and/or community. The need for an I-HITH program led by the Indigenous community was identified during extensive consultation undertaken by Brisbane North Primary Health Network, Metro North Health and Institute of Urban Indigenous Health, the largest Aboriginal community controlled primary healthcare provider in Australia which provides primary health care for approximately 50% of all Indigenous people in the catchment area. Community leaders, clinical, and system leaders have co-designed the I-HITH program with interventions across the health sectors including hospitals, primary and community-based services, and residential aged care. In the I-HITH model, there has been the establishment of a Primary Care Pathway whereby the GP has admitting rights and retains governance of the patient whilst they are admitted. In the process of establishing this innovative and integrated model of care for Indigenous people in Australia, there have been positive experiences and lessons learnt that could be valuable for other countries especially if the goal is to deliver timely and effectively care for priority groups of peoples. These include 1) co-design process in system innovation and changes in healthcare settings; 2) leadership and cross-sectorial partnerships focusing on integrated care transitions between organisations; 3) clinical governance especially from the whole person perspective in their care plans; 4) incremental referrals to I-HITH ensuring the shared-decision making process that aligns with clients’ values and principles; 5) evaluation team in the whole journey of the development, implementation, and outcome assessment, and continuous quality improvement. The program evaluation includes measures of process, implementation, and outcomes using mixed methods. The team is now ready to receive its first patient.

The Ngaa-bi-nya framework presented here is a practical guide for the evaluation of Aboriginal and Torres Strait Islander health and social programs. It has a range of prompts to stimulate thinking about critical success factors in programs relevant to Aboriginal and Torres Strait Islander people’s lives. Ngaa-bi-nya was designed from an Aboriginal practitioner-scholar standpoint and was informed by the holistic concept of Aboriginal health, case studies with Aboriginal-led social and emotional well-being programs, human rights instruments, and the work of Stufflebeam. Aboriginal and Torres Strait Islander health and social programs have been described as suffering from a lack of evaluation. Ngaa-bi-nya is one of the few tools developed specifically to reflect Aboriginal and Torres Strait Islander peoples’ contexts. It prompts the user to take into account the historical, policy, and social landscape of Aboriginal and Torres Strait Islander people’s lives, existing and emerging cultural leadership, and informal caregiving that supports programs. Ngaa-bi-nya’s prompts across four domains—landscape factors, resources, ways of working, and learnings—provide a structure through which to generate insights necessary for the future development of culturally relevant, effective, translatable, and sustainable programs required for Australia’s growing and diverse Aboriginal and Torres Strait Islander populations.

Arts-based prison programs are often viewed as hobbies or as activities that have little impact on prisoner rehabilitation according to conventional understandings of the term. This is despite growing evidence that arts-based programs can assist with learning retention and can improve self-confidence and ways of coping with emotions. Generally, arts practices have been found to assist Aboriginal and Torres Strait Islander people who have grown up or live in urban areas with asserting and strengthening their cultural identity, but we know little about the effects of arts-based prison programs on Aboriginal and Torres Strait Islander prisoner wellbeing. This article focuses on a creative writing program for Aboriginal and Torres Strait Islander prisoners at Junee Correctional Centre, New South Wales. The program, Dreaming Inside, has produced seven volumes of poetry and stories. This article combines and reports findings from two evaluations of the program, one using program feedback forms and the other using semi-structured interviews with prisoners who participated in the program. The themes that emerged from both evaluations affirm the program’s efficacy in improving prisoner self-esteem, confidence and wellbeing, and in reigniting and strengthening cultural engagement.

The National Empowerment Project is an innovative Aboriginal-led community empowerment project that has worked with eight Aboriginal and Torres Strait Islander communities across Australia over the period 2012–13. The aim of the Project was to develop, deliver and evaluate a program to: (1) promote positive social and emotional well-being to increase resilience and reduce the high reported rates of psychological distress and suicide among Aboriginal and Torres Strait Islander people; and (2) empower communities to take action to address the social determinants that contribute to psychological distress, suicide and self-harm. Using a participatory action research approach, the communities were supported to identify the risk factors challenging individuals, families and communities, as well as strategies to strengthen protective factors against these challenges. Data gathered during Stage 1 were used to develop a 12-month program to promote social and emotional well-being and build resilience within each community. A common framework, based on the social and emotional well-being concept, was used to support each community to target community-identified protective factors and strategies to strengthen individual, family and community social and emotional well-being. Strengthening the role of culture is critical to this approach and marks an important difference between Aboriginal and Torres Strait Islander and non-Indigenous mental health promotion and prevention activities, including suicide prevention. It has significant implications for policy makers and service providers and is showing positive impact through the translation of research into practice, for example through the development of a locally run empowerment program that aims to address the social determinants of health and their ongoing negative impact on individuals, families and communities. It also provides a framework in which to develop and strengthen culture, connectedness and foster self-determination, through better-informed policy based on community-level holistic responses and solutions as opposed to an exclusive focus on single-issue deficit approaches.

AbstractObjectiveTo assess the effectiveness of the Cultural, Social and Emotional Wellbeing Program for reducing psychological distress and enhancing the social and emotional wellbeing of Aboriginal women preparing for release from prison.Study designMixed methods; qualitative study (adapted reflexive thematic analysis of stories of most significant change) and assessment of psychological distress.Setting, participantsAboriginal and Torres Strait Islander women at the Boronia Pre‐release Centre for Women, Perth, Western Australia, May and July 2021.InterventionCultural, Social and Emotional Wellbeing Program (two days per week for six weeks). The Program involves presentations, workshops, activities, group discussions, and self‐reflections designed to enhance social and emotional wellbeing.Main outcome measuresThemes and subthemes identified from reflexive thematic analysis of participants’ stories of most significant change; change in mean psychological distress, as assessed with the 5‐item Kessler Scale (K‐5) before and after the Program.ResultsFourteen of 16 invited women completed the Program; ten participated in its evaluation. They reported improved social and emotional wellbeing, reflected as enhanced connections to culture, family, and community. Mean psychological distress was lower after the Program (mean K‐5 score, 11.3; 95% confidence interval [CI], 9.0–13.6) than before the Program (9.0; 95% CI, 6.5–11.5; P = 0.047).ConclusionThe women who participated in the Program reported personal growth, including acceptance of self and acceptance and pride in culture, reflecting enhanced social and emotional wellbeing through connections to culture and kinship. Our preliminary findings suggest that the Program could improve the resilience of Aboriginal and Torres Strait Islander in contact with the justice system.

Background: this study aimed to develop and pilot test the model of care, Grinnin’ Up Mums & Bubs, to train Aboriginal Health Workers to promote oral health among Aboriginal and Torres Strait Islander pregnant women. Methods: Participatory Action Research was employed to develop the different components of the model (oral health promotion resources, training workshop, and a culturally safe referral pathway to dental services). The model was piloted (pre-post), using an embedded mixed-methods design, to determine the acceptability, satisfaction, and any recommendations made by seven Aboriginal Health Workers at an antenatal service in Western Sydney, Australia. Results: there was a high level of satisfaction with the components of the model of care among the participants, who believed that the model could be integrated into practice. The training showed some improvement in oral health knowledge and confidence. The participants recommended strategies for discussing oral health with Aboriginal and Torres Strait Islander pregnant women, and changes in public health dental policy to ensure that all women would be able to access affordable dental services through the referral pathway. Conclusion: the findings suggest a high level of satisfaction with the model of care among the Aboriginal Health Workers. Further evaluation is needed to confirm the short and long-term impact of the model.

The aim of this study was to prospectively evaluate the impact of a Central Australian cultural awareness training program for health care staff. A mixed methods approach was used. Program participants completed a baseline and post-program questionnaire, which included an attitude scale assessing cultural safety, critical thinking and transformative unlearning, and open-ended questions. An online follow-up survey two months later repeated these questions. Mean scale scores were compared using paired and unpaired t-tests. Qualitative data were analysed thematically. Baseline scale mean was 45.7. At post-program it had statistically significantly increased to 47.3, using both the paired (p<0.01) and unpaired t-test (p=<0.03). By the time of the two-month follow-up it had decreased to 42.2. This was not statistically different from the baseline score with a paired (n=11) t-test (p=<0.37), however the difference was statistically significant with an unpaired t-test (p=<0.01) which included an additional eight respondents. Qualitative feedback was consistently positive. Many respondents learnt new information about the negative effects of colonisation on Aboriginal and/or Torres Strait Islander people, and how this continues to affect current health. Learning about Aboriginal and/or Torres Strait Islander cultures, kinship relationships and systems, and communication styles was identified as directly relevant to work practices. A cultural education program produced positive short-term changes in attitudes and was highly valued by participants. However, it is unclear if these changes are maintained in the medium-term.

Comprehensive primary health care is integral to meaningful client-centred care, with nurses and midwives central to partnership approaches with individuals, families and communities. A primary health model of antenatal care is needed for Aboriginal and Torres Strait Islander women in rural and remote areas, where complex social determinants of health impact on pregnancy outcomes, early years and lifelong health. Staff experiences from a community midwifery-led antenatal program in a remote Western Australian setting were explored, with the aim of investigating program impacts from health service providers’ perspectives. Interviews with 19 providers, including community midwives, child health nurses, program managers, a liaison officer, doctors and community agency staff, examined elements comprising a culturally safe community antenatal program for Aboriginal and Torres Strait Islander women, exploring program benefits and challenges. Thematic analysis derived five themes: Organisational and Accessibility Factors; Culturally Appropriate Support; Staff Availability and Competencies; Collaboration; and Sustainability. The ability of program staff to work in culturally safe partnerships with clients in collaboration with community agencies was essential to building meaningful and sustainable antenatal strategies. Midwifery primary health care competencies were viewed as a strong enabling factor, with potential to reduce health disparities in accordance with Australian Government and research recommendations.

Introduction About 44% of Aboriginal and/or Torres Strait Islander women smoke during pregnancy compared to 12% of their general population counterparts. Evidence-based quit smoking advice received from health care professionals (HCPs) can increase smoking cessation rates. However, HCPs lack culturally appropriate smoking cessation training, which is a major barrier to provision of smoking cessation care for this population. Methods and analysis iSISTAQUIT is a multicentre, single arm study aiming to implement and evaluate the evidence-based, culturally competent iSISTAQUIT smoking cessation training among health practitioners who provide support and assistance to pregnant, Aboriginal and Torres Strait Islander women in Australia. This project will implement the iSISTAQUIT intervention in Aboriginal Medical Services and Mainstream Health Services. The proposed sample size is 10 of each of these services (total N = 20), however if the demand is higher, we will aim to accommodate up to 30 services for the training. Participating sites and their HCPs will have the option to choose one of the two iSISTAQUIT packages available: a) Evaluation- research package b) Training package (with or without continued professional development points). Training will be provided via an online eLearning platform that includes videos, text, interactive elements and a treatment manual. A social media campaign will be conducted from December 2021 to September 2022 to raise brand and issue awareness about smoking cessation for Aboriginal and Torres Strait Islander women in pregnancy. This national campaign will consist of systematic advertising and promotion of iSISTAQUIT and video messages through various social media platforms. Analysis We will use the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to plan, evaluate and report the intervention impact of iSISTAQUIT. Effectiveness of social media campaign will be assessed via social media metrics, cross-sectional surveys, and interviews. Discussion This innovative research, using a multi-component intervention, aims to practically apply and integrate a highly translatable smoking cessation intervention in real-world primary care settings in Aboriginal Medical Services and Mainstream services. The research benefits Aboriginal women, babies and their family and community members through improved support for smoking cessation during pregnancy. The intervention is based on accepted Australian and international smoking cessation guidelines, developed and delivered in a culturally appropriate approach for Aboriginal communities.

The robust evaluation of student equity initiatives is now an expected activity in Australian universities. This paper reports on the development of Swinburne’s Higher Education Participation and Partnerships Program (HEPPP) Evaluation Framework in which the project team adopted a student-centred design approach. The needs of Aboriginal and Torres Strait Islander students were positioned at the heart of the methodology and provided the starting point of explorations of student experiences in interviews and focus groups. We found that psychosocial support activities were critical to Indigenous students and those from low socioeconomic statue and/or regional or remote backgrounds and identified several additional Outcome factors of equity programs. Furthermore, we propose ‘Prosperity’ as a new Impact factor for evaluating equity programs to capture a broader notion of ‘success’. We argue that insights from existing institutional evaluation frameworks need to complement the Student Equity in Higher Education Evaluation Framework (SEHEEF) as Australia’s national framework and inform its continuous improvement.

Background:Aboriginal and Torres Strait Islander people in remote and very remote communities in Australia experience high rates of sexually transmissible infections (STIs), 4- to 29-fold the rates reported for non-Aboriginal people living in remote areas. Young people aged 16–29 years are particularly vulnerable to STIs. The Young Deadly Free (YDF) sexual health youth peer education program was implemented in 15 remote or very remote communities in four Australian jurisdictions in an effort to address endemic STI rates in these communities. The present study sought to evaluate the effect of YDF for Aboriginal young people. Methods: Young people (n = 128) participated in youth peer educator training to deliver peer education sessions on sexual health topics to other young people in their communities. Pre and post surveys were used to examine changes in STI knowledge, attitudes and behavioural intentions of the young people attending the peer education sessions. GHRANITE software extracted deidentified STI testing data for young people attending 13 community health services. Results: Young people (n = 426) attended peer education sessions delivered by trained youth peer educators. Pre and post surveys were completed by 174 and 172 young people respectively (median age 20 years). Gains were reported in STI knowledge, intentions to test (χ2 = 10.58, d.f. = 4, n = 142, P Conclusions: Peer education can enhance the sexual health literacy of young Aboriginal people residing in remote communities. The extent to which knowledge gains result in behaviours that prevent STI transmission requires further evaluation. Normalising STI testing among Aboriginal young people would help reduce feelings of shame.

Background Aboriginal and Torres Strait Islander people in remote and very remote communities in Australia experience high rates of sexually transmissible infections (STIs), 4- to 29-fold the rates reported for non-Aboriginal people living in remote areas. Young people aged 16–29 years are particularly vulnerable to STIs. The Young Deadly Free (YDF) sexual health youth peer education program was implemented in 15 remote or very remote communities in four Australian jurisdictions in an effort to address endemic STI rates in these communities. The present study sought to evaluate the effect of YDF for Aboriginal young people. Methods: Young people (n = 128) participated in youth peer educator training to deliver peer education sessions on sexual health topics to other young people in their communities. Pre and post surveys were used to examine changes in STI knowledge, attitudes and behavioural intentions of the young people attending the peer education sessions. GHRANITE software extracted deidentified STI testing data for young people attending 13 community health services. Results: Young people (n = 426) attended peer education sessions delivered by trained youth peer educators. Pre and post surveys were completed by 174 and 172 young people respectively (median age 20 years). Gains were reported in STI knowledge, intentions to test (χ2 = 10.58, d.f. = 4, n = 142, P &lt; 0.001) and number of STI tests (50.8% increase from baseline). Feelings of shame associated with STI testing remained high (39.5% post survey). Conclusions: Peer education can enhance the sexual health literacy of young Aboriginal people residing in remote communities. The extent to which knowledge gains result in behaviours that prevent STI transmission requires further evaluation. Normalising STI testing among Aboriginal young people would help reduce feelings of shame.

Introduction High rates of dementia among Australian First Nations’ peoples have resulted in an increased demand for dementia knowledge and skills among the primary health care professionals in these communities. The Dementia Extension for Community Healthcare Outcomes (ECHO) program aims to be a culturally safe way of increasing local health workforce capacity by facilitating dementia knowledge, skills and confidence among primary care professionals in First Nations community settings. Dementia ECHO is based on the international evidence-based telementoring programme, Project Extension for Community Healthcare Outcomes. Every Dementia ECHO session is delivered by videoconference and comprises a specialist-led presentation and a case discussion from a primary care health service participant. The aims of this study were to assess the uptake and reach of Dementia ECHO; examine the perceived importance of dementia care and dementia education among Aboriginal and Torres Strait Islander Community Controlled Health Service staff; and evaluate the potential impact of Dementia ECHO on health service staff pertaining to dementia knowledge, confidence to provide dementia care and professional isolation. Method Dementia ECHO service activity data maintained by the programme providers was reviewed to determine uptake and reach. A pre-implementation survey examined Aboriginal and Torres Strait Islander Community Controlled Health Service staff perspectives on the importance of dementia education and the priority of a range of health issues. After each Dementia ECHO session, a brief online survey gathered quantitative and qualitative data regarding the potential impact of the session. Results Of 30 completed pre-implementation surveys, all staff rated dementia education as either very important or important. Salient themes highlighting why it is important are presented. When asked to rank six different health priorities, dementia ( n = 10) and chronic disease ( n = 10) were placed as the top priority. The brief post-session feedback provided 44 complete survey responses demonstrating: perceived improvement in dementia knowledge and skills (88.4%); increased confidence to provide dementia care (83%); and a reduction in professional isolation (88%). Conclusion Dementia ECHO addresses a gap in dementia education that is much needed in health professionals with increasing numbers of First Nations people living with dementia. This current study shows that attending an evidence-based telementoring programme, such as Dementia ECHO, can increase dementia knowledge and confidence to care for someone living with dementia and their families.

This research aims to create and evaluate a model for a culturally appropriate, interactive, multimedia and informative health program for Aboriginal and Torres Strait Islander health workers that aims to improve the capacity to independently control their learning within an attractive learning environment. The research also aims to provide recommendations for policy development and further research. This study involved four phases: program needs assessment, identification of the key factors that should be considered in developing the CD-ROM, model development, and formative evaluation for the model. A general needs assessment as a first step in program development highlighted the presence of continuing education gaps and indicated the need for a new means to deliver a sustainable, efficient and culturally acceptable program. This article explores the second objective in this study, which is the identification of the key factors considered for developing the program. The identification began with a systematic review of the literature which served as background information, followed by qualitative semistructured interviews with diverse key stakeholders to explore their expectations and recommendations. The findings indicated that the most important key factors could be categorised under four main categories: cultural factors, information technology availability and literacy, learning aspects, and interactive multimedia factors. Cultural factors included cultural inclusivity, oral cultural, pre-existing knowledge, and Aboriginal preferred learning styles. Information technology factors concerned technology availability and literacy. Learning aspects highlighted the impact of the learning theory in model design. Interactive multimedia development factors explored included the requirements for the process, fitting and design of the program. Recommendations for program design were also provided.

National strategies are needed to continue to promote the broader benefits of participating in sport and organised physical activity to reduce physical inactivity and related disease burden. This paper employs the RE-AIM framework to evaluate the impact of the federally funded $150 million Move it AUS program in engaging inactive people in sport and physical activity through the Participation (all ages) and Better Ageing (over 65 years) funding streams. A pragmatic, mixed-methods evaluation was conducted to understand the impact of the grant on both the participants, and the funded organisations. This included participant surveys, case studies, and qualitative interviews with funded program leaders. A total of 75% of participants in the Participation stream, and 65% in the Better Ageing stream, were classified as inactive. The largest changes in overall physical activity behaviour were seen among socioeconomically disadvantaged participants and culturally and linguistically diverse participants. Seven key insights were gained from the qualitative interviews: Clarity of who, Partnerships, Communication, Program delivery, Environmental impacts, Governance, and that Physical inactivity must be a priority. The Move It AUS program successfully engaged physically inactive participants. Additional work is needed to better engage inactive people that identify as culturally and linguistically diverse, Aboriginal and/or Torres Strait Islander and those that live in disadvantaged communities in sport and physical activities. Tangible actions from the seven key insights should be adopted into workforce capability planning for the sport sector to effectively engage physically inactive communities.

Men’s sheds are a community-based organisation that allows a space for a community of men to interact and engage with one another with hands-on activities. As such, men’s sheds form an appropriate setting to deliver health and wellbeing initiatives. This review aims to understand the role of Australian men’s sheds with respect to the health and wellbeing of their male participants. This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) following a three-step process of planning, conducting, and reporting the review. All three authors reviewed all the eligible articles. There was significant methodological heterogeneity between the sources identified (n = 11). A narrative synthesis identified three key themes: health promotion, wellbeing, and socialisation; intergenerational mentoring; and Aboriginal and Torres Strait Islander men’s health. Men’s sheds serve as ideal locations for the delivery of initiatives that can positively impact on the health and wellbeing of their male participants. Furthermore, research is needed to explore the implementation and evaluation of these health and wellbeing initiatives for men in their respective communities.

Purpose – The purpose of this paper is to describe the process of development and the pilot implementation of a preventive life skills curriculum for Indigenous middle school students in a very remote community college in the West Arnhem region of North Australia. The curriculum integrates proven educational and psychological techniques with culturally informed notions of relatedness and was developed as a contribution to efforts to prevent alarming rates of suicide among remote Indigenous youth. In this paper, the term, Indigenous refers to Australians of Aboriginal or Torres Strait Islander descent. Design/methodology/approach – Based on reviews of research literature on school-based suicide prevention and social and emotional learning in both general and Indigenous populations, and following detailed community consultations, a 12 week curriculum was drafted and implemented in two middle school classes (combined years 7-9). Lessons were videotaped and later analyzed and detailed commentary was sought from participating school staff. Findings – The pilot program has yielded important insights into requirements of a curriculum for young people with low English literacy levels and with variable school attendance patterns. It confirmed the need to adjust both pedagogical approach and curriculum content for the program to have resonance with students from this linguistic and cultural background and with varying levels of exposure to multiple stressors in disadvantaged community settings. Practical implications – The project has identified and resolved key questions for sustainable implementation of a preventive curriculum in challenging community circumstances. Originality/value – There are to date no examples of the systematic adaptation and design of a universal preventive intervention specifically for remote Australian Indigenous youth. The project is the first step toward the formal evaluation of the efficacy of a classroom-based approach to suicide prevention in remote community schools.

The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing identifies building a strong Aboriginal and Torres Strait Islander led evidence-base to inform care as a key priority. Aboriginal and/or Torres Strait Islander adolescents in contact with the criminal justice system are a highly vulnerable group of Australians, with substantial unmet needs. There is limited evidence to inform culturally appropriate models of care that meet the social and emotional wellbeing needs of justice-involved Aboriginal and/or Torres Strait Islander adolescents. This project aims to develop, implement and evaluate an in-reach and community transitional model of social and emotional wellbeing care for Aboriginal and/or Torres Strait Islander adolescents (10–17 years old) who experience detention through close engagement with Aboriginal and/or Torres Strait Islander youth, Elders, researchers, practitioners and community members, and by drawing on culturally informed practice and knowledge systems. The project is based on a multi-level mixed methods design, with a strong focus on ongoing project evaluation (based on the Ngaa-bi-nya framework) and co-design. Co-design is facilitated through culturally safe and trauma informed participatory processes based on development of strong partnerships from project initiative, design, implementation and evaluation. Application of the landscape domain of the Ngaa-bi-nya framework for Aboriginal and Torres Strait Islander program evaluation will be explored in Phase one. Aboriginal and Torres Strait Islander adolescents with experience in detention will be engaged through one-on-one interviews with data collection through the Growth and Empowerment Measure (GEM) Youth (which will be adapted from the adult version and validated as part of this study), the Kessler Psychological Distress Scale (K-10), questions around alcohol and drug use, and narrative interviews exploring experience. Qualitative data will be analyzed using an inductive thematic approach, structured within the framework of the Ngaa-bi-nya landscape prompts. Quantitative data will be analyzed using descriptive statistics to provide a profile of the cohort. Findings from Phase one will be used to inform the development of a model of social and emotional wellbeing care that will be implemented and evaluated in Phase two.

Abstract Aboriginal and Torres Strait Islander holistic health represents the interconnection of social, emotional, spiritual and cultural factors on health and well-being. Social factors (education, employment, housing, transport, food and financial security) are internationally described and recognised as the social determinants of health. The social determinants of health are estimated to contribute to 34% of the overall burden of disease experienced by Aboriginal and Torres Strait Islander people. Primary health care services currently ‘do what it takes’ to address social and emotional well-being needs, including the social determinants of health, and require culturally relevant tools and processes for implementing coordinated and holistic responses. Drawing upon a research-setting pilot program, this manuscript outlines key elements encapsulating a strengths-based approach aimed at addressing Aboriginal and Torres Strait Islander holistic social and emotional well-being. The Cultural Pathways Program is a response to community identified needs, designed and led by Aboriginal and Torres Strait Islander people and informed by holistic views of health. The program aims to identify holistic needs of Aboriginal and Torres Strait Islander people as the starting point to act on the social determinants of health. Facilitators implement strengths-based practice to identify social and cultural needs (e.g. cultural and community connection, food and financial security, housing, mental health, transport), engage in a goal setting process and broker connections with social and health services. An integrated culturally appropriate clinical supervision model enhances delivery of the program through reflective practice and shared decision making. These embedded approaches enable continuous review and improvement from a program and participant perspective. A developmental evaluation underpins program implementation and the proposed culturally relevant elements could be further tailored for delivery within primary health care services as part of routine care to strengthen systematic identification and response to social and emotional well-being needs.

Indigenous cross-cultural training has been around since the 1980s. It is often seen as a way to increase the skills and competency of staff engaged in providing service to Indigenous clients and customers, teaching Indigenous students within universities and schools, or working with Indigenous communities (Fredericks and Bargallie, “Indigenous”; “Which Way”). In this article we demonstrate how such training often exposes power, whiteness, and concepts of an Indigenous “other”. We highlight how cross-cultural training programs can potentially provide a setting in which non-Indigenous participants can develop a deeper realisation of how their understandings of the “other” are formed and enacted within a “white” social setting. Revealing whiteness as a racial construct enables people to see race, and “know what racism is, what it is not and what it does” (Bargallie, 262). Training participants can use such revelations to develop their racial literacy and anti-racist praxis (Bargallie), which when implemented have the capacity to transform inequitable power differentials in their work with Indigenous peoples and organisations.What Does the Literature Say about Cross-Cultural Training? An array of names are used for Indigenous cross-cultural training, including cultural awareness, cultural competency, cultural responsiveness, cultural safety, cultural sensitivity, cultural humility, and cultural capability. Each model takes on a different approach and goal depending on the discipline or profession to which the training is applied (Hollinsworth). Throughout this article we refer to Indigenous cross-cultural training as “cultural competence” or “cultural awareness” and discuss these in relation to their application within higher education institutions. While literature on health and human services programs in Australia, Canada, New Zealand, and other nation states provide clear definitions of terms such as “cultural safety”, cultural competence or cultural awareness is often lacking a concise and consistent definition.Often delivered as a half day or a one to two-day training course, it is unrealistic to think that Indigenous cultural competence can be achieved through one’s mere attendance and participation. Moreover, when courses centre on “cultural differences” and enable revelations about those differences they are in danger of presenting idealised notions of Indigeneity. Cultural competence becomes a process through which an Indigenous “other” is objectified, while very little is offered by way of translating knowledge and skills into practice when working with Indigenous peoples.What this type of learning has the capacity to do is oversimplify and reinforce racism and racist stereotypes of Indigenous peoples and Indigenous cultures. What is generally believed is that if non-Indigenous peoples know more about Indigenous peoples and cultures, relationships between Indigenous and non-Indigenous peoples will somehow improve. The work of Goenpul scholar Aileen Moreton-Robinson is vital to draw on here, when she asks, has the intellectual investment in defining our cultural differences resulted in the valuing of our knowledges? Has the academy become a more enlightened place in which to work, and, more important, in what ways have our communities benefited? (xvii)What is revealed in a range of studies – whether centring on racism and discrimination or the ongoing disparities across health, education, incarceration, employment, and more – is that despite forty plus years of training focused on understanding cultural differences, very little has changed. Indigenous knowledges continue to be devalued and overlooked. Everyday and structural racisms shape everyday experiences for Indigenous employees in Australian workplaces such as the Australian Public Service (Bargallie) and the Australian higher education sector (Fredericks and White).As the literature demonstrates, the racial division of labour in such institutions often leaves Indigenous employees languishing on the lower rungs of the employment ladder (Bargallie). The findings of an Australian university case study, discussed below, highlights how power, whiteness, and concepts of “otherness” are exposed and play out in cultural competency training. Through their exposure, we argue that better understandings about Indigenous Australians, which are not based on culture difference but personal reflexivity, may be gained. Revealing What Was Needed in the Course’s Foundation and ImplementationThis case study is centred within a regional Australian university across numerous campuses. In 2012, the university council approved an Aboriginal and Torres Strait Islander strategy, which included a range of initiatives, including the provision of cross-cultural training for staff. In developing the training, a team explored the evidence as it related to university settings (Anning; Asmar; Butler and Young; Fredericks; Fredericks and Thompson; Kinnane, Wilks, Wilson, Hughes and Thomas; McLaughlin and Whatman). This investigation included what had been undertaken in other Australian universities (Anderson; University of Sydney) and drew on the recommendations from earlier research (Behrendt, Larkin, Griew and Kelly; Bradley, Noonan, Nugent and Scales; Universities Australia). Additional consultation took place with a broad range of internal and external stakeholders.While some literature on cross-cultural training centred on the need to understand cultural differences, others exposed the problems of focusing entirely on difference (Brach and Fraser; Campinha-Bacote; Fredericks; Spencer and Archer; Young). The courses that challenged the centrality of cultural difference explained why race needed to be at the core of its training, highlighting its role in enabling discussions of racism, bias, discrimination and how these may be used as means to facilitate potential individual and organisational change. This approach also addressed stereotypes and Eurocentric understandings of what and who is an Indigenous Australian (Carlson; Gorringe, Ross and Forde; Hollinsworth; Moreton-Robinson). It is from this basis that we worked and grew our own training program. Working on this foundational premise, we began to separate content that showcased the fluidity and diversity of Indigenous peoples and refrained from situating us within romantic notions of culture or presenting us as an exotic “other”. In other words, we embraced work that responded to non-Indigenous people’s objectified understandings and expectations of us. For example, the expectation that Indigenous peoples will offer a Welcome to Country, performance, share a story, sing, dance, or disseminate Indigenous knowledges. While we recognise that some of these cultural elements may offer enjoyment and insight to non-Indigenous people, they do not challenge behaviours or the nature of the relationships that non-Indigenous people have with Aboriginal and Torres Strait Islander peoples (Bargallie; Fredericks; Hollinsworth; Westwood and Westwood; Young).The other content which needed separating were the methods that enabled participants to understand and own their standpoints. This included the use of critical Indigenous studies as a form of analysis (Moreton-Robinson). Critical race theory (Delgado and Stefancic) was also used as a means for participants to interrogate their own cultural positionings and understand the pervasive nature of race and racism in Australian society and institutions (McLaughlin and Whatman). This offered all participants, both non-Indigenous and Indigenous, the opportunity to learn how institutional racism operates, and maintains discrimination, neglect, abuse, denial, and violence, inclusive of the continued subjugation that exists within higher education settings and broader society.We knew that the course needed to be available online as well as face-to-face. This would increase accessibility to staff across the university community. We sought to embed critical thinking as we began to map out the course, including the theory in the sections that covered colonisation and the history of Indigenous dispossession, trauma and pain, along with the ongoing effects of federal and state policies and legislations that locates racism at the core of Australian politics. In addition to documenting the ongoing effects of racism, we sought to ensure that Indigenous resistance, agency, and activism was highlighted, showing how this continues, thus linking the past to the contemporary experiences of Indigenous peoples.Drawing on the work of Bargallie we wanted to demonstrate how Aboriginal and Torres Strait Islander peoples experience racism through systems and structures in their everyday work with colleagues in large organisations, such as universities. Participants were asked to self-reflect on how race impacts their day-to-day lives (McIntosh). The final session of the training focused on the university’s commitment to “Closing the Gap” and its Reconciliation Action Plan (RAP). The associated activity involved participants working individually and in small groups to discuss and consider what they could contribute to the RAP activities and enact within their work environments. Throughout the training, participants were asked to reflect on their personal positioning, and in the final session they were asked to draw from these reflections and discuss how they would discuss race, racism and reconciliation activities with the governance of their university (Westwood and Westwood; Young).Revelations in the Facilitators, Observers, and Participants’ Discussions? This section draws on data collected from the first course offered within the university’s pilot program. During the delivery of the in-person training sessions, two observers wrote notes while the facilitators also noted their feelings and thoughts. After the training, the facilitators and observers debriefed and discussed the delivery of the course along with the feedback received during the sessions.What was noticed by the team was the defensive body language of participants and the types of questions they asked. Team members observed how there were clear differences between the interest non-Indigenous participants displayed when talking about Aboriginal and Torres Strait Islander peoples and a clear discomfort when they were asked to reflect on their own position in relation to Indigenous people. We noted that during these occasions some participants crossed their arms, two wrote notes to each other across the table, and many participants showed discomfort. When the lead facilitator raised this to participants during the sessions, some expressed their dislike and discomfort at having to talk about themselves. A couple were clearly unhappy and upset. We found this interesting as we were asking participants to reflect and talk about how they interpret and understand themselves in relation to Indigenous people and race, privilege, and power.This supports the work of DiAngelo who explains that facilitators can spend a lot of time trying to manage the behaviour of participants. Similarly, Castagno identifies that sometimes facilitators of training might overly focus on keeping participants happy, and in doing so, derail the hard conversations needed. We did not do either. Instead, we worked to manage the behaviours expressed and draw out what was happening to break the attempts to silence racial discussions. We reiterated and worked hard to reassure participants that we were in a “safe space” and that while such discussions may be difficult, they were worth working through on an individual and collective level.During the workshop, numerous emotions surfaced, people laughed at Indigenous humour and cried at what they witnessed as losses. They also expressed anger, defensiveness, and denial. Some participants revelled in hearing answers to questions that they had long wondered about; some openly discussed how they thought they had discovered a distant Aboriginal relative. Many questions surfaced, such as why hadn’t they ever been told this version of Australian history? Why were we focusing on them and not Aboriginal people? How could they be racist when they had an Aboriginal friend or an Aboriginal relative?Some said they felt “guilty” about what had happened in the past. Others said they were not personally responsible or responsible for the actions of their ancestors, questioning why they needed to go over such history in the first place? Inter-woven within participants’ revelations were issues of racism, power, whiteness, and white privilege. Many participants took a defensive stance to protect their white privilege (DiAngelo). As we worked through these issues, several participants started to see their own positionality and shared this with the group. Clearly, the revelation of whiteness as a racial construct was a turning point for some. The language in the group also changed for some participants as revelations emerged through the interrogation and unpacking of stories of racism. Bargallie’s work exploring racism in the workplace, explains that “racism”, as both a word and theme, is primarily absent in conversations amongst non-Indigenous colleagues. Despite its entrenchment in the dialogue, it is rarely, if ever addressed. In fact, for many non-Indigenous people, the fear of being accused of racism is worse than the act of racism itself (Ahmed; Bargallie). We have seen this play out within the media, sport, news bulletins, and more. Lentin describes the act of denying racism despite its existence in full sight as “not racism”, arguing that its very denial is “a form of racist violence” (406).Through enhancing racial literacy, Bargallie asserts that people gain a better understanding of “what racism is, what racism is not and how race works” (258). Such revelations can work towards dismantling racism in workplaces. Individual and structural racism go hand-in-glove and must be examined and addressed together. This is what we wanted to work towards within the cultural competency course. Through the use of critical Indigenous studies and critical race theory we situated race, and not cultural difference, as central, providing participants with a racial literacy that could be used as a tool to challenge and dismantle racism in the workplace.Revelations in the Participant Evaluations?The evaluations revealed that our intention to disrupt the status quo in cultural competency training was achieved. Some of the discussions were difficult and this was reflected in the feedback. It was valuable to learn that numerous participants wanted to do more through group work, conversations, and problem resolution, along with having extra reading materials. This prompted our decision to include extra links to resource learning materials through the course’s online site. We also opted to provide all participants with a copy of the book Indigenous Australia for Dummies (Behrendt). The cost of the book was built into the course and future participants were thankful for this combination of resources.One unexpected concern raised by participants was that the course should not be “that hard”, and that we should “dumb down” the course. We were astounded considering that many participants were academics and we were confident that facilitators of other mandatory workplace training, for example, staff Equal Employment Opportunity (EEO), Fire Safety, Risk Management, Occupational Health and Safety, Discrimination and more, weren’t asked to “dumb down” their content. We explained to the participants what content we had been asked to deliver and knew their responses demonstrated white fragility. We were not prepared to adjust the course and dumb it down for white understandings and comfortabilities (Leonardo and Porter).Comments that were expected included that the facilitators were “passionate”, “articulate”, demonstrated “knowledge” and effectively “dealt with issues”. A couple of the participants wrote that the facilitators were “aggressive” or “angry”. This however is not new for us, or new to other Aboriginal women. We know Aboriginal women are often seen as “aggressive” and “angry”, when non-Indigenous women might be described as “passionate” or “assertive” for saying exactly the same thing. The work of Aileen Moreton-Robinson in Australia, and the works of numerous other Aboriginal women provide evidence of this form of racism (Fredericks and White; Bargallie; Bond). Internationally, other Indigenous women and women of colour document the same experiences (Lorde). Participants’ assessment of the facilitators is consistent with the racism expressed through racial microaggression outside of the university, and in other organisations. This is despite working in the higher education sector, which is normally perceived as a more knowledgeable and informed environment. Needless to say, we did not take on these comments.The evaluations did offer us the opportunity to adjust the course and make it stronger before it was offered across the university where we received further evaluation of its success. Despite this, the university decided to withdraw and reallocate the money to the development of a diversity training course that would cover all equity groups. This meant that Aboriginal and Torres Strait Islander peoples would be covered along with sexual diversity, gender, disability, and people from non-English speaking backgrounds. The content focused on Aboriginal and Torres Strait Islander peoples was reduced to one hour of the total course. Including Aboriginal and Torres Strait Islander peoples in this way is not based on evidence and works to minimise Indigenous Australians and their inherent rights and sovereignty to just another “equity group”. Conclusion We set out to develop and deliver a cross-cultural course that was based on evidence and a foundation of 40 plus years’ experience in delivering such training. In addition, we sought a program that would align with the university’s Reconciliation Action Plan and the directions being undertaken in the sector and by Universities Australia. Through engaging participants in a process of critical thinking centring on race, we developed a training program that successfully fostered self-reflection and brought about revelations of whiteness.Focusing on cultural differences has proven ineffective to the work needed to improve the lives of Indigenous Australian peoples. 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Abstract Background Increasingly, strength-based approaches to health and wellbeing interventions with Aboriginal and Torres Strait Islander Australians are being explored. This is a welcome counter to deficit-based initiatives which can represent a non-Indigenous view of outcomes of interest. However, the evidence base is not well developed. This paper presents the protocol for evaluating a strengths-based initiative which provides life coaching services to Aboriginal and Torres Strait Islander community housing tenants. The study aims to evaluate the effect of life coaching on social and emotional wellbeing (SEWB) of tenants in three Victorian regions. Methods The More Than a Landlord (MTAL) study is a prospective cohort study of Aboriginal Housing Victoria tenants aged 16 years and over that embeds the evaluation of a life coaching program. All tenant holders in one metropolitan and two regional areas of Victoria are invited to participate in a survey of SEWB, containing items consistent with key categories of SEWB as understood and defined by Aboriginal and Torres Strait Islander peoples, and key demographics, administered by Aboriginal and Torres Strait Islander peer researchers at baseline, 6 and 18 months. Survey participants are then invited to participate in strengths based life coaching, using the GROW model, for a duration of up to 18 months. Indigenous life coaches provide tenants with structured support in identifying and making progress towards their goals and aspirations, rather than needs. The study aims to recruit a minimum of 200 survey participants of which it is anticipated that approximately 73% will agree to life coaching. Discussion The MTAL study is a response to Aboriginal and Torres Strait Islander community and organisational requests to build the evidence base for an initiative originally developed and piloted within an Aboriginal controlled organisation. The study design aligns with key principles for research in Indigenous communities in promoting control, decision making and capacity building. The MTAL study will provide essential evidence to evaluate the effectiveness of strengths-based initiatives in promoting SEWB in these communities and provide new evidence about the relationship between strengths, resilience, self-determination and wellbeing outcomes. Trial registration This trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID:ISRCTN33665735.

AbstractThere is increasing international interest in the idea that well-being and health are related to resilience. Participative community singing is beneficial for well-being not only in people who are free from health problems, but especially for those whose physical and mental health is compromised. This study examined the development of five Aboriginal and Torres Strait Islander singing groups and the benefits relating to promoting resilience and ultimately preventing chronic disease in this population. Mixed methods, including both quantitative and qualitative approaches, were used. Questionnaires were administered to collect data on chronic life stresses, resilience, social support and social connectedness. Focus group interviews were conducted to obtain data on the participants’ and stakeholders’ perceptions of the impact of the singing groups. Multivariate analysis of variance was used to test the effectiveness of the intervention program on improving resilience at both the individual and the community levels. Structural equation modelling was used to analyse the pathways from the benefits gained from the singing program to the prevention of chronic disease. The results suggested that the singing groups served multiple functions, which are underpinned by social ecological resilience mechanisms to promote self-esteem, learning and education and confidence at the individual level, as well as community connectedness, reduction of loneliness and promoting social support from family, community and the social context such as support from community-controlled health services, and ultimately preventing chronic disease.

Abstract Background Multiple culturally-oriented programs, services, and frameworks have emerged in recent decades to support the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander (Aboriginal) people in Australia. Although there are some common elements, principles, and methods, few attempts have been made to integrate them into a set of guidelines for policy and practice settings. This review aims to identify key practices adopted by programs and services that align with the principles of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023. Methods A comprehensive review of electronic databases and organisational websites was conducted to retrieve studies of relevance. Twenty-seven publications were included in the review. Next, we identified promising practices through a collaborative review process. We then used the principles articulated in the above-mentioned framework as the basis to complete a framework analysis. This enabled us to explore the alignment between current scholarship about SEWB programs and services with respect to the principles of the framework. Results We found there was a strong alignment, with selected principles being effectively incorporated into most SEWB program and service delivery contexts. However, only one study incorporated all nine principles, using them as conceptual framework. Additionally, ‘capacity building’, ‘individual skill development’, and ‘development of maladaptive coping mechanisms’ were identified as common factors in SEWB program planning and delivery for Aboriginal people. Conclusion We argue the selective application of nationally agreed principles in SEWB programs and services, alongside a paucity of scholarship relating to promising practices in young people-oriented SEWB programs and services, are two areas that need the urgent attention of commissioners and service providers tasked with funding, planning, and implementing SEWB programs and services for Aboriginal people. Embedding robust participatory action research and evaluation approaches into the design of such services and programs will help to build the necessary evidence-base to achieve improved SEWB health outcomes among Aboriginal people, particularly young people with severe and complex mental health needs.

The child protection system in Australia includes out-of-home care (OoHC) for children and young people at risk of harm and neglect. In Australia, Aboriginal and Torres Strait Islander children and young people are 9 times more likely to be placed in care than non-Aboriginal young people (Australian Institute of Health and Welfare, 2015). Australia’s history of colonization and subsequent policies have caused trauma to individuals, families, and communities and resulted in poor physical and mental health and mistrust of services. This review was undertaken to identify programs and policies currently in place that aim to improve the mental health and well-being of this vulnerable population. It provides an analysis of both the strengths of the current system as well as what has been inadequately addressed based on literature in the area.By incorporating an Aboriginal perspective, this review focuses on social, emotional, and spiritual well-being (SESWB) and the aspects of a child’s life and community that promote this. A realist review of the academic and grey literature was conducted in 2014. It included an extensive search of government and non-government (NGO) publications. The review identified nine programs or policies that are designed to improve the SESWB of Aboriginal young people in OoHC in local and international settings. These are the Aboriginal and Torres Strait Islander Child Placement Principle, cultural support plans, Aboriginal Community Controlled Organisations (ACCOs), family group decision-making, therapeutic care, and Panyappi Mentoring Program. Given that culturally competent service provision is important to SESWB, the review concludes that an increase in monitoring and evaluation is necessary to determine the effectiveness of programs and ensure their implementation and sustainability when warranted. Policy and research work is needed to adapt and devise programs promoting the SESWB of Aboriginal young people (at both the individual and system levels), determine their effectiveness, and ensure they are sustained when warranted.

Abstract Background With increasingly tough graduated driver licensing laws in all Australian States and Territories, driver licensing support programs are recognised as being important to support Aboriginal and Torres Strait Islander peoples to obtain a driver licence. Such programs appear to improve licensing attainment rates, but few studies have examined the broader impact that these programs can have. This research aims to 1) examine the impact of a New South Wales (NSW) based driver licensing support program (Driving Change) on client employment outcomes; 2) assess the influence of geographical area of program delivery on driver licence attainment. Methods Driving Change was delivered from February 2013 to August 2016 in 4 urban and 7 regional Aboriginal communities of NSW. Clients were followed-up at 6 months or more following contact with the program as part of routine program operations. Descriptive statistics and regression models were used to analyse data. Results From 933 clients contacted 254 agreed to provide feedback, a response rate of 27%. Those that responded were mostly female (57%), aged 24 years and under (72%), unemployed (85%) with secondary education or less (71%) and from a regional area (74%). Adjusted logistic regression indicated that clients who achieved an independent licence were more likely (OR: 2.5, 95% CI: 1.22–5.24, p = 0.011) of reporting a new job or change in job than those who did not attain a licence. Clients from regional areas were more likely (OR: 1.72, 95% CI: 1.27–2.33, p < 0.001) to gain an independent licence than those from urban areas. There was no difference in employment outcomes (OR: 1.2, 95% CI: 0.53–2.52, p = 0.719) for clients from urban compared to regional areas. Conclusion The Driving Change program appears to be effective in improving employment outcomes for those who gained a licence. Clients from regional areas were more likely to gain a licence compared to those in urban settings, and were predominantly young and unemployed, often a hard to reach cohort. Future licensing programs being delivered in regional areas need integrated pathways into employment opportunities to provide holistic services that address the social and economic challenges faced by Aboriginal and Torres Strait Islander Australians.

Abstract Background Research can inform culturally-appropriate care to strengthen social and emotional wellbeing (SEWB) among Aboriginal and Torres Strait Islander (hereafter, the term ‘Indigenous Peoples’ is respectfully used and refers to all Aboriginal and/or Torres Strait Islander Peoples of Australia). We acknowledge the cultural diversity of Australia’s Indigenous First Peoples and they do not represent a homogenous group.) (hereafter Indigenous) Peoples. We explore the perspectives of primary healthcare staff and Indigenous patients about their willingness to and experiences participating in SEWB research. Method Process evaluation using grounded theory approaches of Getting it Right: The validation study, a national validation designed Indigenous SEWB research project (N = 500). Primary healthcare staff (n = 36) and community members (n = 4) from nine of ten primary healthcare services involved with the research project completed qualitative semi-structured interviews. Interview data were triangulated with participant feedback (responses to structured questions and free-text feedback collected during Getting it Right), study administrative data (participant screening logs, communication logs, study protocol, deviation logs and ethics correspondence) and interviewer field notes. Results Three themes about staff, patient and community perspectives concerning research participation developed: (1) considering the needs, risk, preferences and impact of participation in research for staff, patients and community; (2) building staff confidence speaking to patients about research and SEWB problems and (3) patients speaking openly about their SEWB. Some staff described pressure to ensure patients had a positive experience with the research, to respond appropriately if patients became upset or SEWB problems were identified during interviews, or due to their dual role as community member and researcher. Patients and staff reported that patients were more likely to participate if they knew the staff outside of the service, especially staff with a shared cultural background, and they perceived SEWB as a community priority. Staff reported their skills speaking to patients about the research and SEWB improved during the research, which built their confidence. Contrary to staff preconceptions, staff and patients reported that many patients appreciated the opportunity to speak about their SEWB and contributing to research that may eventually enhance SEWB in their community. Conclusion Our research project was considered acceptable by most staff and patients. The positive outcomes reported by staff and feedback from patients highlights the importance of providing opportunities for people to speak about their SEWB and for research-informed SEWB PHC care. Trial registration Getting it Right is registered on ANZCTR12614000705684.

ABSTRACTBackgroundThe ‘PenCS Flu Topbar’ app was deployed in Central Queensland (CQ), Australia, medical practices through a pilot programme in March 2021.MethodsWe evaluated the app's user experience and examined whether the introduction of ‘PenCS Flu Topbar’ in medical practices could improve the coverage of NIP‐funded influenza vaccinations. We conducted a mixed‐method study including a qualitative analysis of in‐depth interviews with key end‐users and a quantitative analysis of influenza vaccine administrative data.Results‘PenCS Flu Topbar’ app users reported positive experiences identifying patients eligible for NIP‐funded seasonal influenza vaccination. A total of 3606 NIP‐funded influenza vaccinations was administered in the eight intervention practices, 14% higher than the eight control practices. NIP‐funded vaccination coverage within practices was significantly higher in the intervention practices (31.2%) than in the control practices (27.3%) (absolute difference: 3.9%; 95% CI: 2.9%–5.0%; p < 0.001). The coverage was substantially higher in Aboriginal and Torres Strait Islander people aged more than 6 months, pregnant women and children aged 6 months to less than 5 years for the practices where the app was introduced when compared to control practices: incidence rate ratio (IRR) 2.4 (95% CI: 1.8–3.2), IRR 2.7 (95% CI: 1.8–4.2) and IRR 2.3 (1.8–2.9) times higher, respectively.ConclusionsOur evaluation indicated that the ‘PenCS Flu Topbar’ app is useful for identifying the patients eligible for NIP‐funded influenza vaccination and is likely to increase NIP‐funded influenza vaccine coverage in the eligible populations. Future impact evaluation including a greater number of practices and a wider geographical area is essential.

Abstract Background Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4–17 years). This paper outlines a protocol for implementing such complex community-driven research. Methods/design Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children’s social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated. Discussion The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform.

Abstract Background Chronic diseases are the leading contributor to the excess morbidity and mortality burden experienced by Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) people, compared to their non-Indigenous counterparts. The Home-based Outreach case Management of chronic disease Exploratory (HOME) Study provided person-centred, multidisciplinary care for Indigenous people with chronic disease. This model of care, aligned to Indigenous peoples’ conceptions of health and wellbeing, was integrated within an urban Indigenous primary health care service. We aimed to determine the impact of this model of care on participants’ health and wellbeing at 12 months. Methods HOME Study participants were Indigenous, regular patients of the primary health care service, with a diagnosis of at least one chronic disease, and complex health and social care needs. Data were collected directly from participants and from their medical records at baseline, and 3, 6 and 12 months thereafter. Variables included self-rated health status, depression, utilisation of health services, and key clinical outcomes. Participants’ baseline characteristics were described using frequencies and percentages. Generalized estimating equation (GEE) models were employed to evaluate participant attrition and changes in outcome measures over time. Results 60 participants were enrolled into the study and 37 (62%) completed the 12-month assessment. After receiving outreach case management for 12 months, 73% of participants had good, very good or excellent self-rated health status compared with 33% at baseline (p < 0.001) and 19% of participants had depression compared with 44% at baseline (p = 0.03). Significant increases in appointments with allied health professionals (p < 0.001) and medical specialists other than general practitioners (p = 0.001) were observed at 12-months compared with baseline rates. Mean systolic blood pressure decreased over time (p = 0.02), but there were no significant changes in mean HbA1c, body mass index, or diastolic blood pressure. Conclusions The HOME Study model of care was predicated on a holistic conception of health and aimed to address participants’ health and social care needs. The positive changes in self-rated health and rates of depression evinced that this aim was met, and that participants received the necessary care to support and improve their health and wellbeing.

Annual seasonal influenza epidemics cause substantial disease and economic burden worldwide. During the coronavirus disease 2019 (COVID-19) pandemic in 2020 and 2021, influenza activity significantly declined. However, influenza resurged in Australia following the relaxation of non-pharmaceutical interventions, with increased influenza virus circulation in early 2022 coinciding with the SARS-CoV-2 Omicron BA.2 variant wave. Together with other respiratory virus diseases, these disease impacts on the Australian population and healthcare system have re-emphasised the importance of influenza vaccination and control. We aim to provide an overview of the current seasonal influenza vaccination program in Australia and summarise evidence and considerations underpinning potential future immunisation strategies. Influenza causes disproportionately higher morbidity and mortality in young children and older adults. Other populations at elevated risk from influenza include Aboriginal and Torres Strait Islander peoples, pregnant women, and people with certain underlying medical conditions. All Australians aged ≥ 6 months are recommended to receive influenza vaccine every year. The National Immunisation Program (NIP) provides free vaccine for eligible at-risk populations. While approximately 70% of older adults had received influenza vaccine in 2022, coverage in other age groups remains suboptimal. There are several key unmet needs and challenges, but also potential strategies for enhancing the influenza vaccination program in Australia. Improved monitoring and evaluation, including the use of relevant linked datasets for such purposes, is imperative to better understand variations in coverage and vaccination impact in specific populations. Adoption of evidence-based strategies, such as culturally appropriate resources that consider the characteristics of diverse Australian populations, may also help to achieve higher vaccine coverage rates. Additionally, greater vaccine uptake across the population could be facilitated by expanding the NIP-eligible population where cost-effective, and adopting the use of more effective and different types of vaccines when available.

IntroductionFestivals, according to Chris Gibson and John Connell, are like “glue”, temporarily sticking together various stakeholders, economic transactions, and networks (9). Australia’s First Nations peoples see festivals as an opportunity to display cultural vitality (Henry 586), and to challenge a history which has rendered them absent (587). The 2017 Australia Council for the Arts Showcasing Creativity report indicates that performing arts by First Nations peoples are under-represented in Australia’s mainstream venues and festivals (1). Large Aboriginal cultural festivals have long thrived in Australia’s northern half, but have been under-developed in the south. Each regional happening develops a cultural landscape connected to a long and intimate relationship with the natural environment.The Far South East coast and mountainous hinterland of New South Wales is rich in pristine landscapes that ground the Yuin and Monaro Nations to Country as the Monaroo Bobberrer Gadu (Peoples of the Mountains and the Sea). This article highlights cross-sector interaction between Koori and mainstream organisations in producing the Giiyong (Guy-Yoong/Welcoming) Festival. This, the first large festival to be held within the Yuin Nation, took place on Aboriginal-owned land at Jigamy, via Eden, on 22 September 2018. Emerging regional artists joined national headline acts, most notably No Fixed Address (one of the earliest Aboriginal bands to break into the Australian mainstream music industry), and hip-hop artist Baker Boy (Danzal Baker, Young Australian of the Year 2019). The festival followed five years of sustained community preparation by South East Arts in association with Grow the Music, Twofold Aboriginal Corporation, the Eden Local Aboriginal Land Council, and its Elders. We offer dual understandings of the Giiyong Festival: the viewpoints of a male Yuin Elder wedded to an Australian woman of European descent. We acknowledge, and rely upon, key information, statistics, and photographs provided by the staff of South East Arts including Andrew Gray (General Manager), Jasmin Williams (Aboriginal Creative and Cultural Engagement Officer and Giiyong Festival Project Manager), and Kate Howarth (Screen Industry Development Officer). We are also grateful to Wiradjuri woman Alison Simpson (Program Manager at Twofold Aboriginal Corporation) for valuable feedback. As community leaders from First Nations and non-First Nations backgrounds, Simpson and Williams complement each other’s talents for empowering Indigenous communities. They plan a 2020 follow-up event on the basis of the huge success of the 2018 festival.The case study is informed by our personal involvement with community. Since the general population barely comprehends the number and diversity of Australia’s Indigenous ‘nations’, the burgeoning Indigenous festival movement encourages First Nations and non-First Nations peoples alike to openly and confidently refer to the places they live in according to Indigenous names, practices, histories, and knowledge. Consequently, in the mental image of a map of the island-continent, the straight lines and names of state borders fade as the colours of the Indigenous ‘Countries’ (represented by David Horton’s wall map of 1996) come to the foreground. We reason that, in terms of ‘regionality,’ the festival’s expressions of “the agency of country” (Slater 141) differ vastly from the centre-periphery structure and logic of the Australian colony. There is no fixed centre to the mutual exchange of knowledge, culture, and experience in Aboriginal Australia. The broader implication of this article is that Indigenous cultural festivals allow First Nations peoples cultures—in moments of time—to assume precedence, that is to ‘stitch’ back together the notion of a continent made up of hundreds of countries, as against the exploitative structure of ‘hub and region’ colonial Australia.Festival Concepts and ContextsHoward Becker observed that cultural production results from an interplay between the person of the artist and a multitude of support personnel whose work is not frequently studied: “It is through this network of cooperation that the art work we eventually see or hear comes to be and continues to be” (1). In assisting arts and culture throughout the Bega Valley, Eurobodalla, and Snowy Monaro, South East Arts delivers positive achievements in the Aboriginal arts and cultural sector. Their outcomes are significant in the light of the dispossession, segregation, and discrimination experienced by Aboriginal Australians. Michael Young, assisted by Indigenous authors Ellen Mundy and Debbie Mundy, recorded how Delegate Reserve residents relocating to the coast were faced with having their lives controlled by a Wallaga Lake Reserve manager or with life on the fringes of the towns in shacks (2–3). But as discovered in the records, “their retention of traditional beliefs, values and customs, reveal that the accommodation they were forced to make with the Europeans did not mean they had surrendered. The proof of this is the persistence of their belief in the value of their culture” (3–4). The goal of the Twofold Aboriginal Corporation is to create an inclusive place where Aboriginal people of the Twofold Bay Region can be proud of their heritage, connect with the local economy, and create a real future for their children. When Simpson told Williams of the Twofold Aboriginal Corporation’s and Eden Local Aboriginal Land Council’s dream of housing a large cultural festival at Jigamy, Williams rigorously consulted local Indigenous organisations to build a shared sense of community ownership of the event. She promoted the festival as “a rare opportunity in our region to learn about Aboriginal culture and have access to a huge program of Aboriginal musicians, dancers, visual artists, authors, academics, storytellers, cooks, poets, creative producers, and films” (McKnight).‘Uncle Ossie’ Cruse of Eden envisaged that the welcoming event would enliven the longstanding caring and sharing ethos of the Yuin-Monaro people. Uncle Ossie was instrumental in establishing Jigamy’s majestic Monaroo Bobberrer Gudu Keeping Place with the Eden Local Aboriginal Land Council in 1994. Built brick by brick by Indigenous workers, it is a centre for the teaching and celebration of Aboriginal culture, and for the preservation of artefacts. It represents the local community's determination to find their own solutions for “bridging the gap” by creating education and employment opportunities. The centre is also the gateway to the Bundian Way, the first Aboriginal pathway to be listed on the NSW State Heritage Register. Festival Lead-Up EventsEden’s Indigenous students learn a revived South Coast language at Primary and Secondary School. In 2015, Uncle Ossie vitally informed their input into The Black Ducks, a hip-hop song filmed in Eden by Desert Pea Media. A notable event boosting Koori musical socialisation was a Giiyong Grow the Music spectacle performed at Jigamy on 28 October 2017. Grow the Music—co-founded by Lizzy Rutten and Emily White—specialises in mentoring Indigenous artists in remote areas using digital recording equipment. Eden Marine High School students co-directed the film Scars as part of a programme of events with South East Arts and the Giiyong Festival 2018. The Eden Place Project and Campbell Page also create links between in- and out-of-school activities. Eden’s Indigenous students thus perform confidently at NAIDOC Week celebrations and at various festivals. Preparation and PersonnelAn early decision was made to allow free entry to the Giiyong Festival in order to attract a maximum number of Indigenous families. The prospect necessitated in-kind support from Twofold Aboriginal Corporation staff. They galvanised over 100 volunteers to enhance the unique features of Jigamy, while Uncle Ossie slashed fields of bushes to prepare copious parking space. The festival site was spatially focused around two large stages dedicated to the memory of two strong supporters of cultural creativity: Aunty Doris Kirby, and Aunty Liddy Stewart (Image 1). Image 1: Uncle Ossie Cruse Welcomes Festival-Goers to Country on the Aunty Liddy Stewart Stage. Image Credit: David Rogers for South East Arts, Reproduction Courtesy of South East Arts.Cultural festivals are peaceful weapons in a continuing ontological political contest (Slater 144). In a panel discussion, Uncle Ossie explained and defended the Makarrata: the call for a First Nations Voice to be enshrined in the Constitution.Williams also contracted artists with a view to capturing the past and present achievements of Aboriginal music. Apart from her brilliant centrepiece acts No Fixed Address and Baker Boy, she attracted Pitjantjatjara singer Frank Yamma (Image 2), Yorta Yorta singer/songwriter Benny Walker, the Central Desert Docker River Band, and Jessie Lloyd’s nostalgic Mission Songs Project. These stellar acts were joined by Wallaga Lake performers Robbie Bundle, Warren Foster, and Alison Walker as well as Nathan Lygon (Eden), Chelsy Atkins (Pambula), Gabadoo (Bermagui), and Drifting Doolgahls (Nowra). Stage presentations were technologically transformed by the live broadcast of acts on large screens surrounding the platforms. Image 2: Singer-Songwriter Frank Yamma Performs at Giiyong Festival 2018. Image Credit: David Rogers for South East Arts, Reproduction Courtesy of South East Arts.Giiyong Music and Dance Music and dance form the staple components of Indigenous festivals: a reflection on the cultural strength of ancient ceremony. Hundreds of Yuin-Monaro people once attended great corroborees on Mumbulla Mountain (Horton 1235), and oral history recorded by Janet Mathews evidences ceremonies at Fishy Flats, Eden, in the 1850s. Today’s highly regarded community musicians and dancers perform the social arrangements of direct communication, sometimes including their children on stage as apprentices. But artists are still negotiating the power structures through which they experience belonging and detachment in the representation of their musical identity.Youth gain positive identities from participating alongside national headline acts—a form of learning that propels talented individuals into performing careers. The One Mob Dreaming Choir of Koori students from three local schools were a popular feature (Image 3), as were Eden Marine student soloists Nikai Stewart, and Nikea Brooks. Grow the Music in particular has enabled these youngsters to exhibit the roots of their culture in a deep and touching way that contributes to their life-long learning and development. Image 3: The One Mob Dreaming Choir, Directed by Corinne Gibbons (L) and Chelsy Atkins (R). Image Credit: David Rogers for South East Arts, Reproduction Courtesy of South East Arts. Brydie-Leigh Bartleet describes how discourses of pride emerge when Indigenous Australian youth participate in hip-hop. At the Giiyong Festival the relationship between musical expression, cultural representation, and political positioning shone through the songs of Baker Boy and Gabadoo (Image 4). Channelling emotions into song, they led young audiences to engage with contemporary themes of Indigeneity. The drones launched above the carpark established a numerical figure close on 6,000 attendees, a third of whom were Indigenous. Extra teenagers arrived in time for Baker Boy’s evening performance (Williams), revealing the typical youthful audience composition associated with the hip-hop craze (Image 5).Image 4: Bermagui Resident Gabadoo Performs Hip-Hop at the Giiyong Festival. Image Credit: David Rogers for South East Arts, Reproduced Courtesy South East Arts.Image 5: A Youthful Audience Enjoys Baker Boy’s Giiyong Festival Performance. Image Credit: David Rogers for South East Arts, Reproduced Courtesy South East Arts.Wallaga Lake’s traditional Gulaga Dancers were joined by Bermagui’s Gadhu Dancers, Eden’s Duurunu Miru Dancers, and Narooma’s Djaadjawan Dancers. Sharon Mason founded Djaadjawan Dancers in 2015. Their cultural practice connects to the environment and Mingagia (Mother Earth). At their festival tent, dancers explained how they gather natural resources from Walbanja Country to hand-make traditional dance outfits, accessories, and craft. They collect nuts, seeds, and bark from the bush, body paint from ancient ochre pits, shells from beaches, and bird feathers from fresh roadkill. Duurunu Miru dancer/didjeriduist Nathan Lygon elaborates on the functions of the Far South East Coast dance performance tradition:Dance provides us with a platform, an opportunity to share our stories, our culture, and our way of being. It demonstrates a beautiful positivity—a feeling of connection, celebration, and inclusion. The community needs it. And our young people need a ‘space’ in which they can grow into the knowledge and practices of their culture. The festival also helped the wider community to learn more about these dimensions. (n.p.)While music and dance were at the heart of the festival, other traditional skills were included, for example the exhibitions mounted inside the Keeping Place featured a large number of visual artists. Traditional bush cooking took place near Lake Pambula, and yarn-ups, poetry, and readings were featured throughout the day. Cultural demonstrations in the Bunaan Ring (the Yuin name for a corroboree circle) included ‘Gum Leaf Playing.’ Robin Ryan explained how the Yuin’s use of cultural elements to entertain settlers (Cameron 79) led to the formation of the Wallaga Lake Gum Leaf Band. As the local custodian of this unique musical practice, Uncle Ossie performed items and conducted a workshop for numerous adults and children. Festival Feedback and Future PlanningThe Giiyong Festival gained huge Indigenous cultural capital. Feedback gleaned from artists, sponsors, supporters, volunteers, and audiences reflected on how—from the moment the day began—the spirit of so many performers and consumers gathered in one place took over. The festival’s success depended on its reception, for as Myers suggests: “It is the audience who create the response to performance and if the right chemistry is achieved the performers react and excel in their presentation” (59). The Bega District News, of 24 September 2018, described the “incredibly beautiful event” (n.p.), while Simpson enthused to the authors:I believe that the amount of people who came through the gates to attend the Giiyong Festival was a testament to the wider need and want for Aboriginal culture. Having almost double the population of Eden attend also highlights that this event was long overdue. (n.p.)Williams reported that the whole festival was “a giant exercise in the breaking down of walls. Some signed contracts for the first time, and all met their contracts professionally. National artists Baker Boy and No Fixed Address now keep in touch with us regularly” (Williams). Williams also expressed her delight that local artists are performing further afield this year, and that an awareness, recognition, and economic impact has been created for Jigamy, the Giiyong Festival, and Eden respectively:We believe that not only celebrating, but elevating these artists and Aboriginal culture, is one of the most important things South East Arts can do for the overall arts sector in the region. This work benefits artists, the economy and cultural tourism of the region. Most importantly it feeds our collective spirit, educates us, and creates a much richer place to live. (Giiyong Festival Report 1)Howarth received 150 responses to her post-event survey. All respondents felt welcome, included, and willing to attend another festival. One commented, “not even one piece of rubbish on the ground.” Vanessa Milton, ABC Open Producer for South East NSW, wrote: “Down to the tiniest detail it was so obvious that you understood the community, the audience, the performers and how to bring everyone together. What a coup to pull off this event, and what a gift to our region” (Giiyong Festival Report 4).The total running cost for the event was $257,533, including $209,606 in government grants from local, state, and federal agencies. Major donor Create NSW Regional Partnerships funded over $100,000, and State Aboriginal Affairs gave $6,000. Key corporate sponsors included Bendigo Bank, Snowy Hydro and Waterway Constructions, Local Land Services Bega, and the Eden Fisherman’s Club. Funding covered artists’ fees, staging, the hiring of toilets, and multiple generators, including delivery costs. South East Arts were satisfied with the funding amount: each time a new donation arrived they were able to invite more performers (Giiyong Festival Report 2; Gray; Williams). South East Arts now need to prove they have the leadership capacity, financial self-sufficiency, and material resources to produce another festival. They are planning 2020 will be similar to 2018, provided Twofold Aboriginal Corporation can provide extra support. Since South East Arts exists to service a wider area of NSW, they envisage that by 2024, they would hand over the festival to Twofold Aboriginal Corporation (Gray; Williams). Forthcoming festivals will not rotate around other venues because the Giiyong concept was developed Indigenously at Jigamy, and “Jigamy has the vibe” (Williams). Uncle Ossie insists that the Yuin-Monaro feel comfortable being connected to Country that once had a traditional campsite on the east side. Evaluation and ConclusionAlthough ostensibly intended for entertainment, large Aboriginal festivals significantly benefit the educational, political, and socio-economic landscape of contemporary Indigenous life. The cultural outpourings and dissemination of knowledges at the 2018 Giiyong Festival testified to the resilience of the Yuin-Monaro people. In contributing to the processes of Reconciliation and Recognition, the event privileged the performing arts as a peaceful—yet powerful truth-telling means—for dealing with the state. Performers representing the cultures of far-flung ancestral lands contributed to the reimagining of a First Nations people’s map representing hundreds of 'Countries.’It would be beneficial for the Far South East region to perpetuate the Giiyong Festival. It energised all those involved. But it took years of preparation and a vast network of cooperating people to create the feeling which made the 2018 festival unique. Uncle Ossie now sees aspects of the old sharing culture of his people springing back to life to mould the quality of life for families. Furthermore, the popular arts cultures are enhancing the quality of life for Eden youth. As the cross-sector efforts of stakeholders and volunteers so amply proved, a family-friendly, drug and alcohol-free event of the magnitude of the Giiyong Festival injects new growth into an Aboriginal arts industry designed for the future creative landscape of the whole South East region. AcknowledgementsMany thanks to Andrew Gray and Jasmin Williams for supplying a copy of the 2018 Giiyong Festival Report. We appreciated prompt responses to queries from Jasmin Williams, and from our editor Rachel Franks. We are humbly indebted to our two reviewers for their expert direction.ReferencesAustralian Government. Showcasing Creativity: Programming and Presenting First Nations Performing Arts. Australia Council for the Arts Report, 8 Mar. 2017. 20 May 2019 <https://tnn.org.au/2017/03/showcasing-creativity-programming-and-presenting-first-nations-performing-arts-australia-council/>.Bartleet, Brydie-Leigh. “‘Pride in Self, Pride in Community, Pride in Culture’: The Role of Stylin’ Up in Fostering Indigenous Community and Identity.” The Festivalization of Culture. Eds. Andy Bennett, Jodie Taylor, and Ian Woodward. New York: Routledge, 2014.Becker, Howard S. Art Worlds. 25th anniversary edition. Berkeley: U of California P, 2008.Brown, Bill. “The Monaroo Bubberer [Bobberer] Gudu Keeping Place: A Symbol of Aboriginal Self-determination.” ABC South East NSW, 9 Jul. 2015. 20 May 2019 <http://www.abc.net.au/local/photos/2015/07/09/4270480.htm>.Cameron, Stuart. "An Investigation of the History of the Aborigines of the Far South Coast of NSW in the 19th Century." PhD Thesis. Canberra: Australian National U, 1987. Desert Pea Media. The Black Ducks “People of the Mountains and the Sea.” <https://www.youtube.com/watch?v=8fbJNHAdbkg>.“Festival Fanfare.” Eden Magnet 28 June 2018. 1 Mar. 2019 <edenmagnet.com.au>.Gibson, Chris, and John Connell. Music Festivals and Regional Development in Australia. Aldershot: Ashgate, 2012.Gray, Andrew. Personal Communication, 28 Mar. 2019.Henry, Rosita. “Festivals.” The Oxford Companion to Aboriginal Art and Culture. Eds. Syvia Kleinert and Margot Neale. South Melbourne: Oxford UP, 586–87.Horton, David R. “Yuin.” Encyclopaedia of Aboriginal Australia. Ed. David R. Horton. Canberra: Aboriginal Studies Press, 1994.———. Aboriginal Australia Wall Map Compiled by David Horton. Aboriginal Studies Press, 1996.Lygon, Nathan. Personal Communication, 20 May 2019.Mathews, Janet. Albert Thomas Mentions the Leaf Bands That Used to Play in the Old Days. Cassette recorded at Wreck Bay, NSW on 9 July 1964 for the Australian Institute of Aboriginal and Torres Strait Islanders (AIATSIS). LAA1013. McKnight, Albert. “Giiyong Festival the First of Its Kind in Yuin Nation.” Bega District News 17 Sep. 2018. 1 Mar. 2019 <https://www.begadistrictnews.com.au/story/5649214/giiyong-festival-the-first-of-its-kind-in-yuin-nation/?cs=7523#slide=2>. ———. “Giiyong Festival Celebrates Diverse, Enduring Cultures.” Bega District News 24 Sep. 2018. 1 Mar. 2019 <https://www.begadistrictnews.com.au/story/5662590/giiyong-festival-celebrates-diverse-enduring-cultures-photos-videos/>.Myers, Doug. “The Fifth Festival of Pacific Arts.” Australian Aboriginal Studies 1 (1989): 59–62.Simpson, Alison. Personal Communication, 9 Apr. 2019.Slater, Lisa. “Sovereign Bodies: Australian Indigenous Cultural Festivals and Flourishing Lifeworlds.” The Festivalization of Culture. Eds. Andy Bennett, Jodie Taylor, and Ian Woodward. London: Ashgate, 2014. 131–46.South East Arts. "Giiyong Festival Report." Bega: South East Arts, 2018.———. Giiyong Grow the Music. Poster for Event Produced on Saturday, 28 Oct. 2017. Bega: South East Arts, 2017.Williams, Jasmin. Personal Communication, 28 Mar. 2019.Young, Michael, with Ellen, and Debbie Mundy. The Aboriginal People of the Monaro: A Documentary History. Sydney: NSW National Parks and Wildlife Service, 2000.

Aunty Mary Graham, Kombu-merri elder and philosopher, writes, “you are not alone in the world.” We have a responsibility to each other, as well as to the land, and violence is the refusal of this relationship that binds us (Rose). Similarly, Emmanuel Levinas, a French-Lithuanian Jewish teacher and philosopher who lived through the Holocaust, writes that, “my freedom does not have the last word; I am not alone” (Levinas, Totality 101). For both writers, the recognition that one is not alone in the world creates an imperative to act ethically. For non-Indigenous educators working in the Indigenous Studies space—as arguably all school teachers are, given the Australian Curriculum—their relationship with Indigenous Australia creates an imperative to consider ethics and responsibility in their work. In this article, I use Emmanuel Levinas’s thinking and writing on epistemological violence and ethics as a first philosophy to consider how pre-service teachers engage with the ethical responsibilities inherent in teaching and learning Indigenous Studies.To begin, I will introduce Emmanuel Levinas and his writing on violence, followed by outlining the ways that Indigenous perspectives are incorporated into the Australian Curriculum. I will finish by sharing some of the reflective writing undertaken by pre-service teachers in a compulsory Indigenous education subject at an Australian university. These data show pre-service teachers’ responses to being called into responsibility and relationality, as well as some of the complexities in avoiding what I term here epistemological violence, a grasping of the other by trying to make the other infinitely knowable. The data present a problematic paradox—when pre-service teachers write about their future praxis, they necessarily defer responsibility to the future. This deferral constructs an image of the future which transcends the present, without requiring change in the here and now.Of note, some of this writing speaks to the violence enacted upon Indigenous peoples through the colonisation of Australia. I have tried to write respectfully about these topics. Yet the violence continues, in part via the traumatic nature of such accounts. As a non-Indigenous educator and researcher, I also acknowledge that such histories of violence have predominantly benefited people like myself and that the Countries on which this article was written (Countries of the sovereign Bindal and Wulgurukaba peoples) have never been ceded.Emmanuel Levinas: Ethics as First PhilosophyEmmanuel Levinas was a French-Lithuanian Jewish teacher and philosopher for whom surviving the Holocaust—where most of his family perished—fundamentally changed his philosophy. Following World War II, Levinas critiqued Heidegger’s philosophy, writing that freedom—an unencumbered being in the world—could no longer be considered the first condition of being human (Levinas, Existence). Instead, the presence of others in the world—an intersubjectivity between oneself and another—means that we are always already responsible for the others we encounter. Seeing the other’s face calls us to be accountable for our own actions, to responsibility. If we do not respect that the other is different to one’s self, and instead try to understand them through our own frames of reference, we commit the epistemological violence of reducing the other to the same (Levinas, Totality 46), bringing their infinity into our own totality.The history of Indigenous and non-Indigenous relations both in Australia and globally has been marked by attempts to bring Indigenous peoples into non-Indigenous orders of knowledge (Nakata, “Cultural Interface”). The word “Aboriginal”, derived from the Latin “of the original”, refers to both Indigenous peoples’ position as original inhabitants of lands, but also to the anthropological idea that Indigenous peoples were early and unevolved prototypes of human beings (Peterson). This early idea of what it means to be Indigenous is linked to the now well-known histories of ontological violence. Aboriginal reserves were set up as places for Aboriginal people to perish, a consequence not just of colonisation, but of the perception that Indigenous people were unfit to exist in a modern society. Whilst such racist ideologies linger today, most discourses have morphed in how they grasp Indigenous people into a non-Indigenous totality. In a context where government-funded special measures are used to assist disadvantaged groups, categories such as the Indigenous/non-Indigenous binary can become violent. The Closing the Gap campaign, for example, is based on this categorical binary, where “sickness=Indigenous” and “whiteness=health”. This creates a “moral imperative upon Indigenous Australians to transform themselves” (Pholi et al. 10), to become the dominant category, to be brought into the totality.Levinas’s philosophical writings provide a way to think through the ethical challenges of a predominantly non-Indigenous teaching workforce being tasked to not just approach the teaching of Indigenous students with more care than previous generations, but to also embed Indigenous perspectives and knowledges into their teaching work. Levinas’s warning of a “disinterested acquisition of knowledge” (Reader 78), seemingly unrestrained by memory or relationships, is useful in two ways. First, for pre-service teachers learning about Indigenous education, Levinas’s work provides a reminder of the ethical responsibilities that all members of a community have to each other. However, this responsibility cannot be predicated on unwittingly approaching Indigenous topics through Western knowledge lenses. Instead, Levinas’s work also reminds us about the ethics of knowledge production which shape how others—in this case Indigenous peoples—come to be known; teachers and pre-service teachers must engage with the politics of knowledge that shape how Indigenous peoples come to be known in educational settings.You Are Not Alone in the World: Indigenous Perspectives in the Australian CurriculumIn 2010, the Australian Curriculum was launched by the Australian Curriculum, Assessment and Reporting Authority (ACARA) with the goal of unifying state-driven curricula into a common approach. Developed from the 2008 Melbourne Declaration on Educational Goals for Young Australians (Ministerial Council for Education, Early Childhood Development and Youth Affairs [MCEECDYA]), the Curriculum has occupied a prominent position in the Australian educational policy space. As well as preparing a future workforce, contemporary Australian education is essentially aspirational, “governed by the promise of something better” (Harrison et al. 234), with the Australian Curriculum appearing to promise the same: there is a concerted effort to ensure that all Australians have access to equitable and excellent educational opportunities, and that all students are represented within the Curriculum. Part of this aspiration included the development of three Cross-Curriculum Priorities (CCPs), focus areas that “give students the tools and language to engage with and better understand their world at a range of levels” (ACARA, “Cross-Curriculum Priorities” para. 1). The first of these CCPs is Aboriginal and Torres Strait Islander Histories and Cultures and is organised into three key concepts: connection to Country/Place; diversity of Aboriginal and Torres Strait Islander cultures; and diversity of Aboriginal and Torres Strait Islanders societies. In the curriculum more broadly, content descriptions govern what is taught across subject areas from Prep to Year 10. Content elaborations—possible approaches to teaching the standards—detail ways that Aboriginal and Torres Strait Islander Histories and Cultures can be incorporated. For example, Year 7 Science students learn that “predictable phenomena on Earth, including seasons and eclipses, are caused by the relative positions of the sun, Earth and the moon”. This can be taught by “researching knowledges held by Aboriginal and Torres Strait Islander Peoples regarding the phases of the moon and the connection between the lunar cycle and ocean tides” (ACARA, “Science” ACSSU115). This curriculum priority mandates that teachers and learners across Australia engage in representations of Indigenous peoples through teaching and learning activities. However, questions about what constitutes the most appropriate activities, when and where they are incorporated into schooling, and how to best support educators to do this work must continue to be asked.As Indigenous knowledges and perspectives are brought into the classroom where this curriculum is played out, they are shaped by the discourses of the space (Nakata, “Cultural Interface”): what is normalised in a classroom, the teachers’ and students’ prior understandings, and the curriculum and assessment expectations of teaching and learning. Nakata refers to this space as the cultural interface, the contested space between Indigenous and Western knowledge systems where disciplinary discourses, practices and histories translate what is known about Indigenous peoples. This creates complexities and anxieties for teachers tasked with this role (Nakata, “Pathways”). Yet to ignore the presence of Indigenous histories, lifeworlds, and experiences would be to act as if non-Indigenous Australia was alone in the world. The curriculum, as a socio-political document, is full of representations of people. As such, care must be given to how teachers are prepared to engage in the complex process of negotiating these representations.The Classroom as a Location of PossibilityThe introduction of the Australian Curriculum has been accompanied by the Australian Professional Standards for Teachers (APST) which govern the requirements for graduating teachers. Two particular standards—1.4 and 2.4—refer to the teaching of Indigenous students and histories, cultures and language. Many initial teacher education programs in Australian universities have responded to the curriculum requirements and the APSTs by developing a specific subject dedicated to Indigenous education. It is difficult to ascertain the success of this work. Many in-service teachers suggest that more knowledge about Indigenous cultures is required to meet the APST, risking an essentialised view of the Indigenous learner (Moodie and Patrick). Further, there is little empirical research on what improves Indigenous students’ educational outcomes, with the research instead focusing on engaging Indigenous students (Burgess et al.). Similarly, there is yet to be a broadscale research program exploring how teacher educators can best educate pre-service teachers to improve educational outcomes for Indigenous students. Instead, much of the research focuses on engaging (predominantly non-Indigenous) becoming-teachers through a variety of theoretical and pedagogical approaches (Moreton-Robinson et al.) A handful of researchers (e.g. Moodie; Nakata et al.; Page) are considering how to use curriculum design to structure tertiary level Indigenous Studies programs—for pre-service teachers and more generally—to best prepare students to work within complex uncertainties.Levinas’s philosophy reminds us that we need to push beyond thinking about the engagement of Indigenous peoples within the curriculum to the relationship between educator-researchers and their students. Further, Levinas prompts us to question how we can research in this space in a way that is more than just about “disinterested acquisition of knowledge” (Reader 78), instead utilising critical analysis to consider a praxis which ultimately benefits Indigenous students, families and communities. The encounter with Levinas’s writing challenges us to consider how teacher educators can engage with pre-service teachers in a way that does not suggest that they are inherently racist. Rather, we must teach pre-service teachers to not impress the same type of epistemological violence onto Indigenous students, knowledges and cultures. Such questions prompt an engagement with teaching/research which is respectful of the responsibilities to all involved. As hooks reminds us, education can be a practice of freedom: classrooms are locations of possibilities where students can think critically and question taken-for-granted assumptions about the world. To engage with praxis is to consider teaching not just as a practice, but as a theoretically and justice-driven approach. It is with this backdrop that I move now to consider some of the writings of non-Indigenous pre-service teachers.The Research ProjectThe data presented here is from a recent research project exploring pre-service teachers’ experiences of a compulsory Indigenous education subject as part of a four-year initial teacher education degree in an Australian metropolitan university (see McDowall). The subject prepares pre-service teachers to both embed the Aboriginal and Torres Strait Islander Histories and Cultures CCP in their praxis and to teach Indigenous students. This second element engages both an understanding of Indigenous students as inhabiting an intercultural space with particular tensions (Nakata, “Pathways”), and the social-political-historical discourses that impact Indigenous students’ experiences. This includes the history of Indigenous education, the social construction of race, and a critical awareness of deficit approaches to working with Indigenous students. The subject was designed to promote a critical engagement with Indigenous education, to give pre-service teachers theoretical tools to make sense of both how Indigenous students and Indigenous content are positioned in classrooms and develop pedagogical frameworks to enable future teaching work. Pre-service teachers wrote weekly reflective learning journals as an assessment task (weighted at 30% of their total grade). In the final weeks of semester, I asked students in the final weeks of semester for permission to use their journals for a research project, to which 93 students consented.Reading the students’ reflective writing presents a particular ethical paradox, one intricately linked with the act of knowing. Throughout the semester, a desire to gain more knowledge about Indigenous peoples and cultures shifted to a desire to be present as teacher(s) in the Indigenous education landscape. Yet for pre-service teachers with no classroom of their own, this being present is always deferred to the future, mitigating the need for action in the present. This change in the pre-service teachers’ writing demonstrates that the relationship between violence and responsibility is exceedingly complex within the intersection of Indigenous and teacher education. These themes are explored in the following sections.Epistemological ViolenceOne of the shifts which occurred throughout the semester was a subtle difference in the types of knowledges students sought. In the first few weeks of the subject, many of the pre-service teachers wrote of a strong desire to know about Indigenous people and culture as a way of becoming a better educator. Their expectations were around wanting to address their “limited understandings”, wanting to “heighten”, “develop”, and “broaden” “understanding” and “knowledge”; to know “more about them, their culture”. At the end, knowing and understanding is presented in a different type of way. For some students, the knowledge they now want is about their own histories and culture: “as a teacher I need the bravery to acknowledge what happened in the past”, wrote one student in her final entry.For other students, the idea of knowing was shaped by not-knowing. Moving away from a desire to know, and thereby possess, the students wrote about the need to know no longer being present: “I owe my current sense of confidence to that Nakata article. The education system can’t expect all teachers to know exactly how to embed Indigenous pedagogy into their classrooms, can they?” writes one student in her final entry, following on to say, “the main strategy I got from the readings … still stands true: ‘We don’t know everything’ and I will not act like I do”. Another writes, “I am not an expert and I am now aware of the multitude of resources available, particularly the community”.For the students to claim knowledge of Indigenous peoples would be to enact epistemological violence, denying the alterity—difference—of the other and drawing them into our totalities. In the final weeks of the semester, some students wrote that they would use hands-on, outdoor activities in order to enact a culturally responsive pedagogy. Such a claim shows the tenacity of Western knowledge about Indigenous students. In this case, the students’ sentiment can be traced back to Aboriginal Learning Styles (Harris), the idea that Aboriginal students inherently learn via informal hands-on (as opposed to abstract) group approaches. The type of difference promoted in Aboriginal learning styles is biological, suggesting that on account of their Indigeneity, Aboriginal students inherently learn differently. Through its biological function, this difference essentialises Indigenous learners across the nation, claiming a sameness. But perhaps even more violently, it denies the presence of an Indigenous knowledge system in the place where the research took place. Such an Indigenous knowledge system begins from the land, from Country, and entails a rich set of understandings around how knowledge is produced, shared, learnt and, enacted through place and people-based knowledge practices (Verran). Aboriginal learning styles reduces richness to a more graspable concept: informal learning. To summarise, students’ early claims to knowledge shifted to an understanding that it is okay to ‘not know’—to recognise that as beginning teachers, they are entering a complex field and must continue learning. This change is complicated by the tenacity of knowledge claims which define Indigenous students into a Western order of knowledge. Such claims continue to present themselves in the students writing. Nonetheless, as students progressed through the semester and engaged with some of the difficult knowledges and understandings presented, a new form of knowing emerged. Ethical ResponsibilitiesAs pre-service teachers learned about the complex cultural interface of classrooms, they began to reconsider their own claims to be able to ‘know’ Indigenous students and cultures. This is not to say that pre-service teachers do not feel responsibility for Indigenous students: in many journals, pre-service teachers’ wanted-ness in the classroom—their understanding of their importance of presence as teachers—is evident. To write for themselves a need to be present demonstrates responsibility. This took place as students imagined future praxis. With words woven together from several journals, the students’ final entries indicate a wanting-to-be-present-as-becoming-ethical-teachers: I willremember forever, reactionsshocked, sad, guilty. A difference isI don’t feel guilt.I feelI’m not alone.I feelmore aware ofhow I teachhow my opinionscan affect people. I guesswe are the oneswho must makethe change. I feelsomewhat relieved bywhat today’s lecturer said.“If you’re willingto step outfrom behind fencesto engage meaningfullywith Indigenous communitiesit will not be difficult.” I believethe 8-ways frameworkthe unit of workprovide authentic experiencesare perfect avenuesshape pedagogical practicesI believemy job isto embrace remembrancemake this happenmake sure it stays. I willtake away frameworkssupport Indigenous studentsalongside Indigenous teacherslearn from themconsult with communityimprove my teaching. In these students’ words is an assumed responsibility to incorporate Indigenous knowledges and perspectives into their work as teachers. To wish representations of Indigenous peoples and knowledges present in the classroom is one way in which the becoming-teachers are making themselves present. Even a student who had written that she still didn’t feel completely equipped with pedagogical tools still felt “motivated” to introduce “political issues into Australia’s current system”.Not all students wrote of such presence. One student wrote of feeling left “disappointed”, “out of pocket”, “judged” – that the subject had “just ‘ticked the box’” (a phrase used by a second student as well). Another student wrote a short reflection that scratched the surface of the Apology¹, noting that “sorry is something so easy to say”. It is the mixture of these responses which reminds us as researchers and educators that it is easy to write a sense of presence as a projection into the future into an assessment task for a university subject. Time is another other, and the future can never be grasped, can never truly be known (Levinas, Reader). It is always what is coming, for we can only ever experience the present. These final entries by the students claim a future that they cannot know. This is not to suggest that the words written—the I wills and I believes which roll so quickly off the pen—are not meaningful or meant. Rather, responsibility is deferred to the future. This is not just a responsibility for their future teaching. Deferral to the future can also be a way to ease one’s self of the burden of feeling bad about the social injustices which students observe. As Rose (17) writes,The vision of a future which will transcend the past, a future in which current contradictions and current suffering will be left behind enables us to understand ourselves in an imaginary state of future achievement … enables us to turn our backs on current social facts of pain, damage, destruction and despair which exist in the present, but which we will only acknowledge as our past.The pre-service teachers’ reflective writing presents us with a paradox. As they shift away from the epistemological violence of claiming to know Indigenous others from outside positions, another type of violence manifests: claiming a future which can transcend the past just as they defer responsibility within the present. The deferral is in itself an act of violence. What types, then, of presence—a sense of responsibility—can students-as-becoming-professionals demonstrate?ConclusionRose’s words ask us as researchers and educators to consider what it might mean to “do” ethical practice in the “here and now”. When teachers claim that more knowledge about Indigenous peoples will lead to better practice, they negate the epistemological violence of bringing Indigeneity into a Western order of knowledge. Yet even as pre-service teachers’ frameworks shift toward a sense of responsibility for working with Indigenous students, families, and communities—a sense of presence—they are caught in a necessary but problematic moment of deferral to future praxis. A future orientation enables the deflection of responsibility, focusing on what the pre-service teachers might do in the future when they have their own classrooms, but turning their backs on a lack of action in the present. Such a complexity reveals the paradox of assessing learnings for both researchers and university educators. Pre-service teachers—visitors in placement classrooms and students in universities—are always writing and projecting skill towards the future. As educators, we continually ask for students to demonstrate how they will change their future work in a time yet to come. Yet when pre-service teachers undertake placements, their agency to enact difference as becoming-teachers is limited by the totality of the current school programs in which they find themselves. A reflective learning journal, as assessment directed at projecting their future work as teachers, does not enable or ask for a change in the here and now. We must continue to engage in such complexities in considering the potential of epistemological violence as both researchers and educators. Engaging with philosophy is one way to think about what we do (Kameniar et al.) in Indigenous education, a complex field underpinned by violent historical legacies and decades of discursive policy and one where the majority of the workforce is non-Indigenous and working with ideas outside of their own experiences of being. To remember that we are not alone in the world is to stay present with this complexity.ReferencesAustralian Curriculum and Assessment Reporting Authority. “Cross-Curriculum Priorities.” Australian Curriculum. Australian Curriculum and Assessment Reporting Authority, n.d. 23 Apr. 2020 <https://www.australiancurriculum.edu.au/f-10-curriculum/cross-curriculum-priorities/­>.———. “Science.” Australian Curriculum. 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Abstract Focus and outcomes for participants Rationale for the symposium, including for its inclusion in the Congress Cervical cancer, caused by persistent infection with oncogenic human papillomavirus (HPV), is one of the most preventable and treatable forms of cancer, yet more than 300,000 women die from the disease annually and over 500,000 cases are diagnosed. Modelling has shown that effective integration of HPV immunization programmes, HPV-based screening, and access to high-quality cancer treatment and palliative care services has the potential to eliminate cervical cancer in most countries in the world over the next century. In 2018, the Director-General of WHO made a global call to action for the elimination of cervical cancer as a public health problem. As a result, WHO has developed a global strategy towards eliminating cervical cancer as a public health problem due for endorsement at the World Health Assembly in May 2020, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of HPV vaccination of 90%, twice-lifetime cervical screening of 70%, and treatment of pre-invasive lesions and invasive cancer of 90%. As the first country to establish a national HPV immunization programme and one of the first countries to move to an HPV based screening programme, Australia has played a leading role in the global battle against cervical cancer and is on course to eliminate the disease within the next decade. However, while the burden of disease and the highest mortality from cervical cancer occur in lower income countries, factors such as the inequitable cervical cancer burden in Indigenous populations and vaccine hesitancy mean that significant barriers to the elimination of cervical cancer also exists within high-income countries. This session will have seven experts working in four countries within the Asia Pacific region. By sharing experiences and providing evidence-based guidance on key technical and strategic issues, we hope to generate a comprehensive understanding and new knowledge on factors impacting participation in, and the potential for effective scale up of, cervical cancer control programmes within the region. Presentation program Names of presenters -Dr Kate Simms is a Postdoctoral Research Fellow at Cancer Council NSW, Australia. Her research focusses on modelling the impact of HPV vaccination and cervical cancer screening across a range of settings, including predictions for the potential elimination of cervical cancer across 181 countries. -Associate Professor Julia Brotherton is a public health physician and Medical Director of VCS Population Health. She is involved in research and policy development informing the implementation and evaluation of HPV vaccination programs in Australia and is member of the WHO Director General's Expert Advisory Group on Cervical Cancer Elimination. -Assistant Professor Sharon Hanley is a cancer epidemiologist at Hokkaido University, Japan. Her research interests include HPV vaccine hesitancy and HPV self-sampling to increase cervical screening uptake in never/under screened Japanese women. - Associate Professor Lisa Whop is an Indigenous Senior Research Fellow at the Australian National University, Canberra, Australia. Her research focuses on improving health outcomes for Aboriginal and Torres Strait Islander people with cancer, with a key focus on equity. - Dr Megan Smith is a Postdoctoral Research Fellow whose research focuses on optimizing and successfully implementing cervical cancer prevention, at the population level and in different population subgroups. She has contributed to a large number of reports to government, including several evaluations that have directly informed policy in Australia, New Zealand and England. -Professor Andrew Vallely is a clinical epidemiologist at the Kirby Institute, University of New South Wales, Australia. He recently completed a field evaluation comparing point-of-care Xpert HPV testing using self-collected specimens with visual inspection of the cervix with acetic acid (VIA), to detect high-grade cervical disease. - Professor Woo Yin Ling is a Consultant Obstetrician and Gynaecologist at the University of Malaya. She is the programme designer of Project ROSE (Removal of Obstacles to Cervical Screening), a novel cervical screening research programme which employs HPV self-sampling and digital technology to increase access to cervical screening in Malaysia. Names of facilitator or chair Assistant Professor Sharon J.B. Hanley, Hokkaido University and Professor John Kaldor, Kirby Institute, University of New South Wales?