MACKINOLTY, Mr Chips, Manager, Research Advocacy and Policy, Aboriginal Medical Services Alliance Northern Territory

PATERSON, Mr John, Chief Executive Officer, Aboriginal Medical Services Alliance Northern Territory

[10:38]

ACTING CHAIR: I call on representatives of the Aboriginal Medical Services Alliance Northern Territory. We are in the middle of business in the House, so forgive us for coming and going. I am standing in as the Chair. Our Chair, Mr Perrett, has had to go to the chamber. We welcome you as representatives of Aboriginal Peak Organisations Northern Territory. You are here to give us evidence, obviously on the Hansard record. Would either of you like to make an opening statement?

Mr Paterson : Let me first of all acknowledge the Aboriginal traditional owners of the Northern Territory on whose country that we are presenting to you from, and that is the Larrakia people of the Darwin urban region. I take it you have our full submission?

ACTING CHAIR: Yes, we do.

Mr Paterson : Misuse of alcohol has devastating health and social consequences for Northern Territory Aboriginal communities. Foetal alcohol spectrum disorder is one of many alcohol-related health issues faced by Aboriginal people in the Northern Territory. Aboriginal Peak Organisations of the Northern Territory, otherwise referred to as APONT, believes that addressing alcohol and drug misuse in their health and social consequences can only be achieved through a multi-tiered approach. To address alcohol and drug misuse within Aboriginal communities, social and structural deterrents of mental health must be addressed. Public health policies and clinical services which aim to impact on foetal alcohol spectrum disorder must also be guided by evidence and integrated into broader policies aiming to overcome Aboriginal disadvantage and address the issues which underlie substance misuse within our communities. Any genuine approach to prevent and address foetal alcohol spectrum disorder within Aboriginal communities must include evidence based approaches to address the social determinants of health and, specifically, the underlying causes of Aboriginal alcohol abuse as well as being accompanied by strategies to address the ill effects of alcohol consumption.

Supply reduction measures are shown to be the most powerful intervention in reduced alcohol consumption. We believe that introduction of a floor price and regulating outlet density are two priority measures to address alcohol misuse. The most realistic way to reduce harm from alcohol consumption in pregnancy through clinical service delivery is through an integrated approach within the comprehensive primary health care. Aboriginal community-controlled health services provide a range of clinical services that are relevant to the prevention, early detection and management of children with foetal alcohol spectrum disorder. These include screening for hazardous drinking in health checks, high quality antenatal care and universal childhood surveillance. Aboriginal community-controlled health services are leaders in clinical governance and provide the strongest models of comprehensive primary health care delivery. The community-controlled sector recognises a high need for holistic social and emotional wellbeing services to be incorporated within primary health care service delivery.

The Aboriginal Medical Services Alliance Northern Territory model contains a strong preventative community development approach. Within communities this approach is being facilitated by Aboriginal workers who work to enhance the social and emotional wellbeing of communities in culturally informed ways, with the aim of addressing the issues that underlie alcohol misuse. Trauma, including transgenerational trauma, is recognised as a significant underlying issue to substance misuse within Indigenous communities. The Olds model—and that is Professor David Olds—of nurse home visitation and case management of children from vulnerable families provides structured support for pregnant women until the child is aged two. The program has been operating in the USA for over 25 years and has been shown to reduce alcohol and other drug use in mother and child, improve outcomes for educational attainment and reduce rates of child neglect and juvenile offending. The Olds program is already being piloted by selected Aboriginal community controlled health services and should be funded for all willing Aboriginal community controlled health services.

Another example is the Abecedarian program, which is an out-of-home-care model which demonstrates an enriched care approach for children with risk factors for developmental delay, including children with FASD, foetal alcohol spectrum disorder, as well as children who are not receiving enough stimulation and nurturing in their home environment. It has demonstrated long-term sustainable benefits, including educational and social outcomes. All children with high needs due to factors such as physical illness, disability, developmental delays and/or family dysfunction require case management within primary health care.

ACTING CHAIR: This is useful information, particularly the Olds program. We are looking for best practice. Can you give us a little bit more information about that, particularly if it is being used at all in the Top End?

Mr Paterson : I might hand over to our policy adviser, Mr Chips Mackinolty, to give a bit more detail on that one.

Mr Mackinolty : It has been operating for nearly three years at Congress in Alice Springs. It is one of three sites that was funded by the federal government to take on Olds. It is just nearing the completion of an evaluation, but the preliminary results from that are extremely positive. People at Congress have made slight changes to the Olds method, in terms of having Aboriginal family workers involved as well as nurses. That has proved particularly useful in terms of language differences and so on. The disappointment from our sector is that at the last budget, projected funding of Olds sites around the rest of the country—I think there are about another six to be rolled out—sort of fell off the edges in terms of the most recent federal budget.

ACTING CHAIR: So you have only got the Alice Springs project up at the moment?

Mr Mackinolty : There is Alice Springs and I think there is one in Cairns and—I might be wrong—one in New South Wales.

ACTING CHAIR: Are they specifically to do with FASD support?

Mr Mackinolty : No. They are for all kids who are vulnerable, whose mothers are in vulnerable situations. Very often, one of those vulnerabilities is alcohol and other drug problems. From APONT's point of view, we see these sorts of programs as being available to all kids who are vulnerable, which is most Aboriginal kids—every one of them.

ACTING CHAIR: Thank you very much

Mr Paterson : I think that the model is one that enables a comprehensive model of delivery of a broad range of services that are identified by the family. That may be to deal with alcohol, drugs, lack of kids going to school, need for extra tutorials, mum needing to attend a budget course to budget her fortnightly allowances or whatever other income that she may have—the need to get additional and extra support. It is all about services being offered at that preventive end and to work on.

ACTING CHAIR: Are fathers targeted in this Olds program as well? Are fathers systematically targeted as part of improving family outcomes?

Mr Mackinolty : No. It is a family thing, but it is largely targeted at the mother. But then there are other programs, like Abecedarian and other intense family support programs, that do include the broader family, which will be male members of the family as well.

ACTING CHAIR: Okay.

Mr Paterson : But you are right. If we are going to target the family, we should not forget the dads.

ACTING CHAIR: Indeed. In Indigenous communities, the grandmothers typically do most of the child raising, so it is not quite the standard nuclear family model, perhaps.

Mr SYMON: John, I would like to go back to the earlier part of your statement where you were talking about structural and social determinants of health and the need to accompany strategies to address excessive consumption of alcohol. You also spoke at that time about supply reduction being the most effective, and you talked about floor prices and regulating outlet densities. I would like to ask: in your experience what has been the growth in the density of outlets in recent years? Has that been a factor in the increase of FASD in communities?

Mr Paterson : Madam Acting Chair, I am just seeking guidance. I had not finished the paper. Do you want us to take—

ACTING CHAIR: We have your written submission. Is your oral contribution substantially different to your written submission?

Mr Paterson : There was only half a page left. That was all.

ACTING CHAIR: Do you want to summarise it? The reason why I was intervening was that we have members coming and going, and I was keen for us to ask questions before we lost our quorum.

Mr Paterson : There are two paragraphs, if I may.

ACTING CHAIR: Excellent.

Mr Paterson : There is strong evidence and universal agreement of the fundamental importance of education in underpinning the future health, wealth and economic security. Changes such as positive rather than negative messaging around parental responsibility and school attendance, as well as ensuring a flexible curriculum that includes Aboriginal languages, cultures and history, would assist children with development delays to learning. Aboriginal Peak Organisations Northern Territory recommends better resourcing of the criminal justice system to enable any person suspected of having developmental or cognitive impairments to be assessed and have access to appropriate case management that informs sentencing dispositions, as diagnosing foetal alcohol spectrum disorder among children and adults is challenging. Some will enter the criminal justice system without appropriate consideration of their impaired functioning by the court. That is the end of it.

ACTING CHAIR: Can I just pass back to our chair, Mr Perrett. He has just been able to return from the chamber, so it is over to our chair.

CHAIR: Thanks very much, Dr Stone, for stepping in. You were saying? I interrupted you.

Mr Mackinolty : We have been interrupting each other. It was quite hard for me just then, because there is a huge echo happening. Just going back to the question, there was a question just before Mr Paterson finished the statement then on the evidence of density of outlets and increases in FASD. The simple answer is that no-one knows, because in the first instance FASD is very difficult to diagnose, especially among Aboriginal kids and especially as it is very much a spectrum disorder. What we can say is that, where there is high density, increased density or increased sales of grog, a whole range of grog-related problems including FASD do increase significantly. The corollary of that is that if you can reduce alcohol consumption, especially for pregnant women, then FASD is hopefully going to diminish substantially, but so will all of the other social and emotional problems to do with grog.

CHAIR: So the reduction in supply is a wider measure that then has an impact on the rate of consumption?

Mr Paterson : Yes. But in terms of pregnant women, especially young pregnant women, obviously if we can deal with the issue in terms of primary healthcare settings you are then starting to deal with all those other problems that surround why a young woman is drinking, about her living conditions and the social setting and so on. If she is surrounded in her home or in a town camp or something like that with quite massive levels of drinking, it is very difficult for a young woman in that situation to get the guts to get out of that syndrome.

Mr SYMON: I think your point is well made, in that it cannot just be one factor. There are many and they all have to be working in the same direction.

Mr Paterson : Yes.

CHAIR: If you had the power to wave a magic wand what would you do? I am not asking you as a constitutional lawyer.

Mr Paterson : Provide an appropriate level of funding so we can roll out more of the Professor David Olds model and those other models that have been tried—

CHAIR: So education and prevention; not closing down bars?

Mr Paterson : Absolutely. I heard your comments on ABC radio, and I totally agree. That is where we get government to support the service-providing agencies and the Aboriginal community—

CHAIR: Mr Paterson, I am not sure if you can hear us—we just lost vision and sound.

Ms SMYTH: Let's call time.

CHAIR: That's it, they're gone.

Ms SMYTH: I would call time. We were going to finish at eleven, anyway, so let's not bother trying to get it back up.

CHAIR: Okay, the secretariat will contact them and say sorry and ask that they add anything that they want to add. Is it the wish of the committee that it authorise the publication, including publication on the parliamentary database, of the transcript of the evidence given before it at the public hearing this day. There being no objection it is so resolved.

The connection is back. Sorry about that guys. We have to finish at 11 am anyway, so we will finish up. We lost you for a minute. If you do have any other additional information that you think of later, send it through to the secretariat. Apologies again that we cannot be there to sit down at the table and have a yarn to you, but these things happen. Thank you. I now declare the public hearing closed. Thank you for your attendance today.

Committee adjourned at 10:57